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General NPI Number Information
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NPI Number | 1164093381
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Entity Type | Individual
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Provider Name | NICOLE MARIE GRIMES OD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 7111 W ALAMEDA AVE UNIT L
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City | LAKEWOOD
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State | CO
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Zip | 80226-3300
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Country | US
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Telephone | 303-934-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 7511 S 28TH TER
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City | PHOENIX
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State | AZ
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Zip | 85042-6047
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Country | US
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Telephone | 480-327-8704
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0003689
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License Number State | CO
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