Provider Demographics
NPI:1043380249
Name:GRUTZMACHER, DONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:GRUTZMACHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 OHIO PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3343
Mailing Address - Country:US
Mailing Address - Phone:513-753-8225
Mailing Address - Fax:513-753-8589
Practice Address - Street 1:486 OHIO PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3343
Practice Address - Country:US
Practice Address - Phone:513-753-8225
Practice Address - Fax:513-753-8589
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3173T465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0345693Medicaid
OHT46839Medicare UPIN
OH0345693Medicaid