Provider Demographics
NPI:1356350540
Name:GRINMAN, YEVGENY (OD)
Entity type:Individual
Prefix:DR
First Name:YEVGENY
Middle Name:
Last Name:GRINMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 RONALD RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4562
Mailing Address - Country:US
Mailing Address - Phone:847-414-3937
Mailing Address - Fax:
Practice Address - Street 1:1013 DAVIS ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3609
Practice Address - Country:US
Practice Address - Phone:847-475-1416
Practice Address - Fax:847-475-1416
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009751Medicaid
IL046009751Medicaid