Provider Demographics
NPI:1215032792
Name:GRYGIER, STEPHEN J (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:GRYGIER
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 1:367 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5005
Mailing Address - Country:US
Mailing Address - Phone:740-382-2020
Mailing Address - Fax:740-382-1941
Practice Address - Street 1:367 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5005
Practice Address - Country:US
Practice Address - Phone:740-382-2020
Practice Address - Fax:740-382-1941
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3517 P509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311015138026Medicaid
OH0463841Medicaid
OH4380060001OtherSUPPLIER ID #-DMEPOS
OH4380060001OtherSUPPLIER ID #-DMEPOS
OH311015138026Medicaid