Provider Demographics
NPI:1235389008
Name:GRANT, WILLIAM M (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:GRANT
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 NEW ATHOL RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-9603
Mailing Address - Country:US
Mailing Address - Phone:978-249-9033
Mailing Address - Fax:978-249-9020
Practice Address - Street 1:119 NEW ATHOL RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-9603
Practice Address - Country:US
Practice Address - Phone:978-249-9033
Practice Address - Fax:978-249-9020
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1430156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
0625540001Medicare PIN