Basic Information
| Provider Information | |||||||||
| NPI: | 1225418791 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STROH | ||||||||
| FirstName: | INNA | ||||||||
| MiddleName: | GRISHKAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GRISHKAN | ||||||||
| OtherFirstName: | INNA | ||||||||
| OtherMiddleName: | V | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.D., PH.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 499 FARMINGTON AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060321933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606780202 | ||||||||
| FaxNumber: | 8606780277 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 S MARIO CAPECCHI DR | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841320005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015812352 | ||||||||
| FaxNumber: | 8015815806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2015 | ||||||||
| LastUpdateDate: | 07/06/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 11166860-1205 | UT | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.