Active NPI
Patricia D Grace, OD
- Optometrist
- Ashtabula, OH
National Provider Identifier
1245333657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T865
- Practice address
- 3551 N Ridge Rd E
Walmart Vision Center
Ashtabula, OH 44004 - Phone
- (440) 998-4014
- Fax
- (440) 998-4017
- NPI assigned
- Sep 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4254 | OH | |
| Optometrist | 152W00000X | T865 | OH | Primary |
Addresses
Primary practice location
3551 N Ridge Rd E
Walmart Vision Center
Ashtabula, OH 44004
Mailing address
3551 N Ridge Rd E
Walmart Vision Center
Ashtabula, OH 44004-4313
Phone (440) 998-4014
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 729418 | Other | OH | OPTICHOICE |
| 52935 | Other | OH | DAVIS VISION |
| 552359 | Other | OH | NVA |
| 20132 | Other | OH | SPECTERA |
| GR729418 | Other | OH | CLARITY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4254 | OH | MD | Optometrist |
| T865 | OH | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245333657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3551 N RIDGE RD E",
"address_2": "WALMART VISION CENTER",
"city": "ASHTABULA",
"state": "OH",
"postal_code": "440044313",
"telephone_number": "440-998-4014",
"fax_number": "440-998-4017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3551 N RIDGE RD E",
"address_2": "WALMART VISION CENTER",
"city": "ASHTABULA",
"state": "OH",
"postal_code": "44004",
"telephone_number": "440-998-4014",
"fax_number": "440-998-4017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRACE",
"first_name": "PATRICIA",
"middle_name": "D",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "4254",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "T865",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTICHOICE",
"identifier": "729418",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAVIS VISION",
"identifier": "52935",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NVA",
"identifier": "552359",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECTERA",
"identifier": "20132",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLARITY",
"identifier": "GR729418",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ashtabula, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.