Individual
MISS DEJANA GRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1331 N 7TH ST, PHOENIX, AZ 85006
(602) 222-2234
(602) 222-3025
Mailing address
3701 WILSHIRE BLVD STE 600, LOS ANGELES, CA 90010-2814
(323) 361-3550
Taxonomy
Speciality
Code
Description
License number
State
152WP0200X
Pediatric Optometrist
Primary
OPT33832
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112409104
—
TX
01
—
1861493140
GROUP NPI
TX
Enumeration date
07/26/2013
Last updated
07/31/2018
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