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NPI Code Detail

MEDICARE: DR. GENE B GRUBBS O.D.

MEDICARE: DR. GENE B GRUBBS O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2095CO

General Provider Information

NPI Number : 1265497481
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GENE B GRUBBS O.D.
Provider Business Mailing Address
First Line : 2360 E PERSHING BLVD
Second Line : CODE 112
City : CHEYENNE
State : WY
Zip : 82001-5356
Country : US
Telephone Number : 307-778-7550
Fax Number :
Provider Business Practice Location Address
First Line : 2360 E PERSHING BLVD
Second Line : CODE 112
City : CHEYENNE
State : WY
Zip : 82001-5356
Country : US
Telephone Number : 307-778-7550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 07/08/2007

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Directions to “ DR. GENE B GRUBBS O.D.” Practice Location

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