Provider Demographics
NPI:1659557189
Name:GREGORY A. GRIFFITH, OD
Entity Type:Organization
Organization Name:GREGORY A. GRIFFITH, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-724-7630
Mailing Address - Street 1:424 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2572
Mailing Address - Country:US
Mailing Address - Phone:814-724-7630
Mailing Address - Fax:814-333-1763
Practice Address - Street 1:424 NORTH ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2572
Practice Address - Country:US
Practice Address - Phone:814-724-7630
Practice Address - Fax:814-333-1763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000519332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30365Medicare UPIN
PA0177300001Medicare NSC