Provider Demographics
NPI:1164569711
Name:GRIFFIN OPTOMETRIC GROUP
Entity Type:Organization
Organization Name:GRIFFIN OPTOMETRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:POWERS
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:949-492-1853
Mailing Address - Street 1:140 AVENIDA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4016
Mailing Address - Country:US
Mailing Address - Phone:949-492-1853
Mailing Address - Fax:
Practice Address - Street 1:140 AVENIDA DEL MAR
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4016
Practice Address - Country:US
Practice Address - Phone:949-492-1853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier