Provider Demographics
NPI:1942827043
Name:GRISSOM, JULIANNE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:MARIE
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:MARIE
Other - Last Name:GOLINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5124 SOUTHWIND RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2231
Mailing Address - Country:US
Mailing Address - Phone:216-212-0360
Mailing Address - Fax:
Practice Address - Street 1:2630 PETERS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5655
Practice Address - Country:US
Practice Address - Phone:336-785-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT4583152W00000X
OH006878152W00000X
MDTA2908152W00000X
NC2752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist