Provider Demographics
NPI:1821343195
Name:GRIESHOP, CHRISTIE M (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:M
Last Name:GRIESHOP
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 1:1025 GRAND LAKE RD
Mailing Address - Street 2:P.O. BOX 377
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1309
Mailing Address - Country:US
Mailing Address - Phone:419-586-3151
Mailing Address - Fax:419-586-1059
Practice Address - Street 1:1025 GRAND LAKE RD
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1309
Practice Address - Country:US
Practice Address - Phone:419-586-3151
Practice Address - Fax:419-586-1059
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0073873Medicaid
OH0073873Medicaid