Provider Demographics
NPI:1003952359
Name:GRIDER, DONNA LOUISE (OD)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LOUISE
Last Name:GRIDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 IRVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1321
Mailing Address - Country:US
Mailing Address - Phone:484-459-3217
Mailing Address - Fax:
Practice Address - Street 1:1250 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2706
Practice Address - Country:US
Practice Address - Phone:610-544-1841
Practice Address - Fax:610-544-2984
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001434152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist