Provider Demographics
NPI:1154329381
Name:GRISNIK, GEORGE J (OD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:GRISNIK
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 1:502 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-2045
Mailing Address - Country:US
Mailing Address - Phone:412-233-3225
Mailing Address - Fax:412-233-5140
Practice Address - Street 1:502 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-2045
Practice Address - Country:US
Practice Address - Phone:412-233-3225
Practice Address - Fax:412-233-5140
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA137544OtherHIGHMARK ID NUMBER
PA3957552OtherCIGNA
PA0000137544OtherAMERIHEALTH ADMINISTRATOR
PA410014692OtherRAILROAD MEDICARE
PA0012770840011Medicaid
236571OtherADVANTRA/ HEALTH AMERICA
PA251183OtherUPMC HEALTH PLAN
0077334OtherAETNA
PA410014692OtherRAILROAD MEDICARE
236571OtherADVANTRA/ HEALTH AMERICA
PA137544OtherHIGHMARK ID NUMBER
PA137544EBLMedicare PIN