Basic Information
| Provider Information | |||||||||
| NPI: | 1386998987 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRASEE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PEARLE VISION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 556 WINDMILL DR | ||||||||
| Address2: | |||||||||
| City: | SAINT LEONARD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206852565 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 23191 THREE NOTCH RD | ||||||||
| Address2: | |||||||||
| City: | CALIFORNIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206196024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018636080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2012 | ||||||||
| LastUpdateDate: | 11/04/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCKIMMIE | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4105869507 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TA1647 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.