Provider Demographics
NPI:1114098217
Name:COLGARY, GRANT LOUIS JR (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:LOUIS
Last Name:COLGARY
Suffix:JR
Gender:M
Credentials:OPTICIAN
Other - Prefix:MRS
Other - First Name:FLORENCE
Other - Middle Name:MARY
Other - Last Name:COLGARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:261 JAMES ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6392
Mailing Address - Country:US
Mailing Address - Phone:973-285-1566
Mailing Address - Fax:973-285-4806
Practice Address - Street 1:261 JAMES ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6392
Practice Address - Country:US
Practice Address - Phone:973-285-1566
Practice Address - Fax:973-285-4806
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD969156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician