Provider Demographics
NPI:1902862329
Name:GRIEGO, CAROLINE (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:GRIEGO
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 1:3120 E UNION HILLS DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3421
Mailing Address - Country:US
Mailing Address - Phone:602-867-4200
Mailing Address - Fax:602-867-4450
Practice Address - Street 1:3120 E UNION HILLS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3421
Practice Address - Country:US
Practice Address - Phone:602-867-4200
Practice Address - Fax:602-867-4450
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0179520OtherBLUE CROSS BLUE SHIELD AZ
AZ0866630001Medicare ID - Type Unspecified