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General NPI Number Information
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NPI Number | 1033122627
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Entity Type | Individual
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Provider Name | MR. NICHOLAS PETER GRINICH
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 235 SE NORTON LN STE A
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City | MCMINNVILLE
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State | OR
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Zip | 97128-8479
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Country | US
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Telephone | 503-472-4688
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Fax | 503-474-4731
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Provider Business Mailing Address
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Address Line | 235 SE NORTON LN STE A
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City | MCMINNVILLE
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State | OR
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Zip | 97128-8479
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Country | US
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Telephone | 503-472-4688
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Fax | 503-474-4731
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD14713
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 23437
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License Number State | AZ
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