Provider Demographics
NPI:1275973125
Name:GRANT, JAMES K
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:GRANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ROLLING KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9274
Mailing Address - Country:US
Mailing Address - Phone:803-781-2123
Mailing Address - Fax:803-749-0183
Practice Address - Street 1:7367 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7619
Practice Address - Country:US
Practice Address - Phone:803-781-2123
Practice Address - Fax:803-749-0183
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist