Provider Demographics
NPI:1750097390
Name:GREGG, CHRISTOPHER P
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:GREGG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6175 CAHILL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1527
Mailing Address - Country:US
Mailing Address - Phone:651-455-1492
Mailing Address - Fax:651-455-9466
Practice Address - Street 1:6175 CAHILL AVE STE 101
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1527
Practice Address - Country:US
Practice Address - Phone:651-455-1492
Practice Address - Fax:651-455-9466
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN29109OtherMEDICA
MN1319889OtherMN SALES AND USE TAX NUMBER