=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427067610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRINMAN EYE CARE ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 11/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1013 DAVIS ST
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60201-3609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-475-1416
-----------------------------------------------------
Fax | 847-475-1416
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3233 RONALD RD
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60025-4562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-414-3937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. YEVGENY GRINMAN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 847-475-1416
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 046009751
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------