Provider Demographics
NPI:1255950275
Name:GRIMES, AMIEE MICHELE I
Entity type:Individual
Prefix:
First Name:AMIEE
Middle Name:MICHELE
Last Name:GRIMES
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMIEE
Other - Middle Name:MICHELE
Other - Last Name:RAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3647 HIGHWAY 39
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-2612
Mailing Address - Country:US
Mailing Address - Phone:541-884-5244
Mailing Address - Fax:
Practice Address - Street 1:3647 HIGHWAY 39
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-2612
Practice Address - Country:US
Practice Address - Phone:541-884-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist