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NPI Code Detail

MEDICARE: GRISHAM EYE ASSOCIATES PC

MEDICARE: GRISHAM EYE ASSOCIATES PC
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
1261QS0132XOphthalmologic Surgery Clinic/Center0039OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710094149
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRISHAM EYE ASSOCIATES PC
Provider Business Mailing Address
First Line : 3615 SE KENTUCKY ST
Second Line :
City : BARTLESVILLE
State : OK
Zip : 74006-2324
Country : US
Telephone Number : 918-333-2020
Fax Number : 918-335-3253
Provider Business Practice Location Address
First Line : 3615 SE KENTUCKY ST
Second Line :
City : BARTLESVILLE
State : OK
Zip : 74006-2324
Country : US
Telephone Number : 918-333-2020
Fax Number : 918-335-3253
Authorized Official
Title or Position : PRESIDENT
Name : DR. JEFFREY WILLIAM GRISHAM
Credential : MD
Telephone Number : 918-333-2020
Provider Enumeration Date : 08/23/2006
Last Update Date : 08/28/2008

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