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General NPI Number Information
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NPI Number | 1144340589
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Entity Type | Organization
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Legal Business Name | THOMAS M. GRISCHOW, O.D., INC.
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 199 NILES CORTLAND RD SE
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City | WARREN
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State | OH
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Zip | 44484-2426
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Country | US
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Telephone | 330-856-1782
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Fax | 330-856-2760
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Provider Business Mailing Address
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Address Line | 199 NILES CORTLAND RD SE
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City | WARREN
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State | OH
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Zip | 44484-2426
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Country | US
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Telephone | 330-856-1782
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Fax | 330-856-2760
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS M GRISCHOW
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Credential | O.D.
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Telephone | 330-856-1782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4457 T1113
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License Number State | OH
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