Provider Demographics
NPI:1710416359
Name:GRIMM, AIMEE (OD)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13904 N DALE MABRY HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2446
Mailing Address - Country:US
Mailing Address - Phone:813-908-2020
Mailing Address - Fax:
Practice Address - Street 1:2055 ROUTE 611
Practice Address - Street 2:
Practice Address - City:SWIFTWATER
Practice Address - State:PA
Practice Address - Zip Code:18370-7787
Practice Address - Country:US
Practice Address - Phone:570-839-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist