Provider Demographics
NPI:1467650150
Name:DR, JOHN T. GRIGGS, OPTOMETRIST P.A.
Entity Type:Organization
Organization Name:DR, JOHN T. GRIGGS, OPTOMETRIST P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-464-4362
Mailing Address - Street 1:1538 VICTORIAN HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-7774
Mailing Address - Country:US
Mailing Address - Phone:828-256-4323
Mailing Address - Fax:
Practice Address - Street 1:201 ZELKOVA COURT NW
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9377
Practice Address - Country:US
Practice Address - Phone:828-464-4362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT64997Medicare UPIN
NC246466AMedicare ID - Type Unspecified