Provider Demographics
NPI:1508207572
Name:GRANT, COLIN NICHOLAS (OD,)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:NICHOLAS
Last Name:GRANT
Suffix:
Gender:M
Credentials:OD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:709 PINE ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4604
Practice Address - Country:US
Practice Address - Phone:703-471-7810
Practice Address - Fax:703-471-6549
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist