Healthcare Provider Details

I. General information

NPI: 1215032792
Provider Name (Legal Business Name): STEPHEN J GRYGIER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 S MAIN ST
MARION OH
43302-5005
US

IV. Provider business mailing address

367 S MAIN ST
MARION OH
43302-5005
US

V. Phone/Fax

Practice location:
  • Phone: 740-382-2020
  • Fax: 740-382-1941
Mailing address:
  • Phone: 740-382-2020
  • Fax: 740-382-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3517 P509
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: