Provider Demographics
NPI:1063662062
Name:ROBERT E. GREGG, O.D., INC.
Entity Type:Organization
Organization Name:ROBERT E. GREGG, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-281-2952
Mailing Address - Street 1:1060 CLAREMONT AVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3715
Mailing Address - Country:US
Mailing Address - Phone:419-281-2952
Mailing Address - Fax:419-289-0893
Practice Address - Street 1:1060 CLAREMONT AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3715
Practice Address - Country:US
Practice Address - Phone:419-281-2952
Practice Address - Fax:419-289-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2828/T866332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01233151343Medicaid
OH01233151343Medicaid
OH0157941Medicare PIN