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General NPI Number Information
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NPI Number | 1053488106
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Entity Type | Organization
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Legal Business Name | GRIN EYECARE OF GRANDVIEW, INC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 1024 MAIN ST
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City | GRANDVIEW
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State | MO
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Zip | 64030-2456
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Country | US
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Telephone | 816-761-6337
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Fax | 816-761-3564
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Provider Business Mailing Address
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Address Line | 1024 MAIN ST
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City | GRANDVIEW
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State | MO
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Zip | 64030-2456
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Country | US
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Telephone | 816-761-6337
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Fax | 816-761-3564
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DEBBIE ANN GORDIER
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Credential |
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Telephone | 816-761-6337
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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 | 2004017834
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License Number State | MO
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