Provider Demographics
NPI:1215934641
Name:GRIGSBY, JAMES ROBERT (OD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:GRIGSBY
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 1:307 OAK MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-5505
Mailing Address - Country:US
Mailing Address - Phone:336-878-0754
Mailing Address - Fax:
Practice Address - Street 1:2120 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1410
Practice Address - Country:US
Practice Address - Phone:704-636-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1417152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909032Medicaid
NC0807620002Medicare NSC
NC0807620001Medicare NSC
NC2468996Medicare PIN
NCU48662Medicare UPIN
NC7909032Medicaid