Provider Demographics
NPI:1366826075
Name:GRIMM, ADAM (OD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:GRIMM
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5013
Mailing Address - Country:US
Mailing Address - Phone:781-245-6667
Mailing Address - Fax:781-245-8011
Practice Address - Street 1:336 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5013
Practice Address - Country:US
Practice Address - Phone:781-245-6667
Practice Address - Fax:781-245-8011
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH910152W00000X
MA5337152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist