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NPI Code Detail

MEDICARE: CHRISTOPHER P. GREGG

MEDICARE:   CHRISTOPHER P. GREGG
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
1332H00000XEyewear Supplier

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
129109OTHERMNMEDICA
21319889OTHERMNMN SALES AND USE TAX NUMBER

General Provider Information

NPI Number : 1750097390
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER P. GREGG
Provider Business Mailing Address
First Line : 6175 CAHILL AVE STE 101
Second Line :
City : INVER GROVE HEIGHTS
State : MN
Zip : 55076-1527
Country : US
Telephone Number : 651-455-1492
Fax Number : 651-455-9466
Provider Business Practice Location Address
First Line : 6175 CAHILL AVE STE 101
Second Line :
City : INVER GROVE HEIGHTS
State : MN
Zip : 55076-1527
Country : US
Telephone Number : 651-455-1492
Fax Number : 651-455-9466
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2023
Last Update Date : 06/02/2023

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