Provider Demographics
NPI:1710094149
Name:GRISHAM EYE ASSOCIATES PC
Entity Type:Organization
Organization Name:GRISHAM EYE ASSOCIATES PC
Other - Org Name:GRISHAM EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GRISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-333-2020
Mailing Address - Street 1:3615 SE KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2324
Mailing Address - Country:US
Mailing Address - Phone:918-333-2020
Mailing Address - Fax:918-335-3253
Practice Address - Street 1:3615 SE KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2324
Practice Address - Country:US
Practice Address - Phone:918-333-2020
Practice Address - Fax:918-335-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0039261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100740380BMedicaid
OK100740380BMedicaid