Provider Demographics
NPI:1780814921
Name:MARY GRIMWOOD & ASSOC LTD
Entity Type:Organization
Organization Name:MARY GRIMWOOD & ASSOC LTD
Other - Org Name:DR. MARY M. GRIMWOOD & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIMWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-378-4342
Mailing Address - Street 1:141 N WEBER RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-1504
Mailing Address - Country:US
Mailing Address - Phone:630-378-4342
Mailing Address - Fax:630-378-4147
Practice Address - Street 1:141 N WEBER RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-1504
Practice Address - Country:US
Practice Address - Phone:630-378-4342
Practice Address - Fax:630-378-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty