Provider Demographics
NPI:1083809826
Name:DR MARK L GRISWOLD & ASSOCIATES PLC
Entity Type:Organization
Organization Name:DR MARK L GRISWOLD & ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-797-9700
Mailing Address - Street 1:PO BOX 69610
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-0019
Mailing Address - Country:US
Mailing Address - Phone:520-797-9700
Mailing Address - Fax:520-797-0600
Practice Address - Street 1:1521 E TANGERINE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-6225
Practice Address - Country:US
Practice Address - Phone:520-797-9700
Practice Address - Fax:520-797-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE82039Medicare UPIN
AZ5419130001Medicare NSC
AZZ25131Medicare PIN