Provider Demographics
NPI:1104117589
Name:GRILLO, ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:GRILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:345 COLLEGE ST SE STE C
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1014
Mailing Address - Country:US
Mailing Address - Phone:360-456-3200
Mailing Address - Fax:360-539-3443
Practice Address - Street 1:345 COLLEGE ST SE STE C
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1014
Practice Address - Country:US
Practice Address - Phone:360-456-3200
Practice Address - Fax:360-539-3443
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61233895207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist