Provider Demographics
NPI:1447242912
Name:GRIGSBY, JEFFERY G (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:G
Last Name:GRIGSBY
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 1:4109 N MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3500
Mailing Address - Country:US
Mailing Address - Phone:432-694-5259
Mailing Address - Fax:432-694-7694
Practice Address - Street 1:4109 N MIDLAND DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3500
Practice Address - Country:US
Practice Address - Phone:432-694-5259
Practice Address - Fax:432-694-7694
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3040TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3040TGOtherOPTOMETRY LICENSE
TX130998102Medicaid
TX130998102Medicaid