Provider Demographics
NPI:1861046948
Name:GRYGIER, JASON J (OD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:GRYGIER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N WATER ST UNIT 707
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2557
Mailing Address - Country:US
Mailing Address - Phone:740-602-0130
Mailing Address - Fax:
Practice Address - Street 1:2600 POST RD
Practice Address - Street 2:STE 210
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-3206
Practice Address - Country:US
Practice Address - Phone:203-255-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3108152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist