Robert F. Gradisek, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3172 T921 Issued in OH

Practice address

1142 W 37TH St
Lorain, OH 44052-5115

Phone

(440) 282-6669

Fax

(440) 282-5397

NPI assigned

Apr 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208822400000",
    "number": "1316902331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1142 W 37TH ST",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440525115",
            "telephone_number": "440-282-6669",
            "fax_number": "440-282-5397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1142 W 37TH ST",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440525115",
            "telephone_number": "440-282-6669",
            "fax_number": "440-282-5397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADISEK",
        "first_name": "ROBERT",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2008-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3172 T921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "0525712",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "4100043904",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Selena Marie Gonzalez
• Lisa Kay Goodwin, OCPS, CDCA, TTS
• Christopher Ryan Gordon
• Jody Laine Gordon, DO
• Lynn Marie Gordon, RN, BSN, CNP
• Diane Elaine Gramer
• Gregory Stuart Grant, DO
• Sean Alan Graver, CDCA
• Belinda Gray, LSW
• John H Gray, DO

• Optometrist in Lorain, OH
• Providers in Lorain, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.