Provider Demographics
NPI:1144340589
Name:THOMAS M. GRISCHOW, O.D., INC.
Entity type:Organization
Organization Name:THOMAS M. GRISCHOW, O.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRISCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-856-1782
Mailing Address - Street 1:199 NILES CORTLAND RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2426
Mailing Address - Country:US
Mailing Address - Phone:330-856-1782
Mailing Address - Fax:330-856-2760
Practice Address - Street 1:199 NILES CORTLAND RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2426
Practice Address - Country:US
Practice Address - Phone:330-856-1782
Practice Address - Fax:330-856-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4457 T1113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOP0517OtherEYEMED
OH52322OtherDAVIS VISION
OH29416OtherSPECTERA
OH279544883006OtherMEDICAL MUTUAL
OH7483230OtherAETNA
OH2559539Medicaid
OH000000364655OtherANTHEM
OH29416OtherSPECTERA
OH52322OtherDAVIS VISION
OH279544883006OtherMEDICAL MUTUAL
OH=========030OtherCARESOURCE
OHOP0517OtherEYEMED
OH279544883006OtherMEDICAL MUTUAL
OH29416OtherSPECTERA
ND=========OtherTRICARE