Provider Demographics
NPI:1427067610
Name:GRINMAN EYE CARE ASSOCIATES
Entity type:Organization
Organization Name:GRINMAN EYE CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YEVGENY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-475-1416
Mailing Address - Street 1:3233 RONALD RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4562
Mailing Address - Country:US
Mailing Address - Phone:847-414-3937
Mailing Address - Fax:
Practice Address - Street 1:1013 DAVIS ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3609
Practice Address - Country:US
Practice Address - Phone:847-475-1416
Practice Address - Fax:847-475-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009751Medicaid
5826840001Medicare NSC
IL213999Medicare PIN