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General NPI Number Information
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NPI Number | 1386860443
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Entity Type | Organization
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Legal Business Name | PHILLIP D GRIMES P C
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 1108 E. HIGHWAY 152
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City | MUSTANG
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State | OK
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Zip | 73064-5116
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Country | US
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Telephone | 405-376-2429
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Fax | 405-376-2431
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Provider Business Mailing Address
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Address Line | 1108 E. HIGHWAY 152
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City | MUSTANG
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State | OK
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Zip | 73064-5116
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Country | US
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Telephone | 405-376-2429
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Fax | 405-376-2431
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILLIP DON GRIMES
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Credential | O.D.
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Telephone | 405-376-2429
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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 | 845
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License Number State | OK
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