Provider Demographics
NPI:1144685439
Name:GRANT EYE CARE, LLC
Entity type:Organization
Organization Name:GRANT EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:ACKER
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-612-6016
Mailing Address - Street 1:5219 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-1719
Mailing Address - Country:US
Mailing Address - Phone:662-612-6016
Mailing Address - Fax:662-612-6031
Practice Address - Street 1:5219 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-1719
Practice Address - Country:US
Practice Address - Phone:662-612-6016
Practice Address - Fax:662-612-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS923261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center