Individual
DR. ROBERT F. GRADISEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1142 W 37TH ST, LORAIN, OH 44052-5115
(440) 282-6669
(440) 282-5397
Mailing address
1142 W 37TH ST, LORAIN, OH 44052-5115
(440) 282-6669
(440) 282-5397
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3172 T921
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0525712
MEDICARE PTAN
OH
01
—
4100043904
RAILROAD MEDICARE PIN
OH
Enumeration date
04/20/2006
Last updated
04/22/2008
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