Dejana GRK, OD

Primary specialty

Pediatric OptometristTaxonomy code 152WP0200X

License

OPT33832 Issued in CA

Practice address

1331 N 7TH St
Phoenix, AZ 85006

Phone

(602) 222-2234

Fax

(602) 222-3025

NPI assigned

Jul 26, 2013

Last updated

Jul 31, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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": "1374796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532995200000",
    "number": "1447692793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 WILSHIRE BLVD STE 600",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900102814",
            "telephone_number": "323-361-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 N 7TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85006",
            "telephone_number": "602-222-2234",
            "fax_number": "602-222-3025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1331 N 7th St",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850062754",
            "country_code": "US",
            "telephone_number": "602-222-2234",
            "fax_number": "602-222-3025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRK",
        "first_name": "DEJANA",
        "name_prefix": "Miss",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-26",
        "last_updated": "2018-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "CA",
            "license": "OPT33832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112409104",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1861493140",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cherece Griswold
• Denise Griswold, RD, CDE
• Garret Rex Grizzle, D.O.
• Lindsay Jean Grizzle, MD
• Amanda Grjegian, RBT
• Edward Groce
• Kiley Groebner
• Giamarie Groenenboom
• Darcie M. Groeper, D.O.
• Winter Groeschl, LPC

• Pediatric Optometrist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Pediatric Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; 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.