Provider Demographics
NPI:1316935562
Name:PRICE, JODI GRIMM (OD)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:GRIMM
Last Name:PRICE
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 1:77 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3104
Mailing Address - Country:US
Mailing Address - Phone:740-773-8055
Mailing Address - Fax:740-773-8057
Practice Address - Street 1:77 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3104
Practice Address - Country:US
Practice Address - Phone:740-773-8055
Practice Address - Fax:740-773-8057
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0792487Medicaid
OH0607646Medicare PIN
OH0245790001Medicare NSC
OH0607644Medicare PIN
OHT48696Medicare UPIN
OH0792487Medicaid
OH6038580001Medicare NSC
OH0607645Medicare PIN