Provider Demographics
NPI:1417260340
Name:GRUBB, ELLEN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MARIE
Last Name:GRUBB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:MARIE
Other - Last Name:WOLKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:25 STERLING WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1174
Mailing Address - Country:US
Mailing Address - Phone:859-498-4800
Mailing Address - Fax:859-498-2021
Practice Address - Street 1:25 STERLING WAY
Practice Address - Street 2:SUITE C
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1174
Practice Address - Country:US
Practice Address - Phone:859-498-4800
Practice Address - Fax:859-498-2021
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1807DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist