Provider Demographics
NPI:1093447005
Name:GREIF, TAYLOR MYRANDA (OD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MYRANDA
Last Name:GREIF
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 1:1865 RUTHERFORD AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1840
Mailing Address - Country:US
Mailing Address - Phone:812-664-4307
Mailing Address - Fax:
Practice Address - Street 1:403 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1127
Practice Address - Country:US
Practice Address - Phone:502-647-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2287DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist