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General NPI Number Information
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NPI Number | 1437387834
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Entity Type | Organization
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Legal Business Name | MIDLAND EYE NETWORK,LLP
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 4109 N MIDLAND DR
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City | MIDLAND
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State | TX
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Zip | 79707-3500
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Country | US
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Telephone | 432-559-2227
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Fax |
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Provider Business Mailing Address
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Address Line | 4109 N MIDLAND DR
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City | MIDLAND
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State | TX
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Zip | 79707-3500
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Country | US
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Telephone | 432-559-2227
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JEFF GRIGSBY
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Credential | O.D.
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Telephone | 432-694-5259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2219TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 3317TG
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 3896TG
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 3040TG
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License Number State | TX
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