Provider Demographics
NPI:1245333657
Name:GRACE, PATRICIA D (OD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:GRACE
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 1:3551 N RIDGE RD E
Mailing Address - Street 2:WALMART VISION CENTER
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4313
Mailing Address - Country:US
Mailing Address - Phone:440-998-4014
Mailing Address - Fax:440-998-4017
Practice Address - Street 1:3551 N RIDGE RD E
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004
Practice Address - Country:US
Practice Address - Phone:440-998-4014
Practice Address - Fax:440-998-4017
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4254152W00000X
OHT865152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH729418OtherOPTICHOICE
OH52935OtherDAVIS VISION
OH552359OtherNVA
OH20132OtherSPECTERA
OHGR729418OtherCLARITY
OHU35289Medicare UPIN
OH729418OtherOPTICHOICE