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General NPI Number Information
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NPI Number | 1063662062
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Entity Type | Organization
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Legal Business Name | ROBERT E. GREGG, O.D., INC.
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 1060 CLAREMONT AVE SUITE #5
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City | ASHLAND
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State | OH
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Zip | 44805-3715
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Country | US
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Telephone | 419-281-2952
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Fax | 419-289-0893
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Provider Business Mailing Address
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Address Line | 1060 CLAREMONT AVE SUITE #5
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City | ASHLAND
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State | OH
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Zip | 44805-3715
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Country | US
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Telephone | 419-281-2952
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Fax | 419-289-0893
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT EDWARD GREGG
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Credential | O.D.
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Telephone | 419-281-2952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2828/T866
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License Number State | OH
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