Provider Demographics
NPI:1003289042
Name:JESSICA GRIMES, OD, LLC
Entity Type:Organization
Organization Name:JESSICA GRIMES, OD, LLC
Other - Org Name:FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-896-1622
Mailing Address - Street 1:798 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:798 SOUTHPARK BLVD
Practice Address - Street 2:SUITE 24
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3615
Practice Address - Country:US
Practice Address - Phone:804-524-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002132152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1609137611Medicaid
VV8222AMedicare PIN