Provider Demographics
NPI:1821063769
Name:MILTON B GRIN MD PA
Entity Type:Organization
Organization Name:MILTON B GRIN MD PA
Other - Org Name:GRIN EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-829-5511
Mailing Address - Street 1:PO BOX 219241
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9241
Mailing Address - Country:US
Mailing Address - Phone:913-829-5511
Mailing Address - Fax:913-829-5571
Practice Address - Street 1:21020 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7200
Practice Address - Country:US
Practice Address - Phone:913-829-5511
Practice Address - Fax:913-829-5571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04 22448207W00000X
MOR8F92207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6367830001OtherMEDICARE NSC
KS200569860AMedicaid
MOMA2364OtherMEDICARE
KSCI8603OtherRAILROAD MEDICARE
MOMA2364OtherMEDICARE
KSK380000Medicare PIN