Provider Demographics
NPI:1083055651
Name:GWINNER, GRANT K (OD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:K
Last Name:GWINNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:801 E 3RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELLSWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:67439-4224
Mailing Address - Country:US
Mailing Address - Phone:785-472-3272
Mailing Address - Fax:785-472-3360
Practice Address - Street 1:801 E 3RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:ELLSWORTH
Practice Address - State:KS
Practice Address - Zip Code:67439-4224
Practice Address - Country:US
Practice Address - Phone:785-472-3272
Practice Address - Fax:785-472-3360
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1950152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist