Provider Demographics
NPI:1558544460
Name:THOMAS M GRISCHOW OD INC
Entity Type:Organization
Organization Name:THOMAS M GRISCHOW OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GRISCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-792-0820
Mailing Address - Street 1:6000 MAHONING AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2225
Mailing Address - Country:US
Mailing Address - Phone:330-792-0820
Mailing Address - Fax:330-792-0843
Practice Address - Street 1:6000 MAHONING AVE
Practice Address - Street 2:STE 200
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2225
Practice Address - Country:US
Practice Address - Phone:330-792-0820
Practice Address - Fax:330-792-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0958281Medicaid
OH0958281Medicaid
OHU46782Medicare UPIN
OH9332651Medicare PIN