Individual
TOM X GRUDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
428 SPRUCE ST, SCRANTON, PA 18503-1821
(570) 346-1771
(570) 346-5812
Mailing address
428 SPRUCE ST, SCRANTON, PA 18503-1821
(570) 346-1771
(570) 346-5812
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0498520001
MEDICARE PART B
PA
Enumeration date
07/26/2006
Last updated
02/07/2008
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