Provider Demographics
NPI:1528009214
Name:HAROLD GRANEK MDPA
Entity Type:Organization
Organization Name:HAROLD GRANEK MDPA
Other - Org Name:VITREO-RETINAL CONSULTANTS OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-332-6200
Mailing Address - Street 1:1021 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3021
Mailing Address - Country:US
Mailing Address - Phone:817-332-6200
Mailing Address - Fax:817-332-8730
Practice Address - Street 1:1021 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3021
Practice Address - Country:US
Practice Address - Phone:817-332-6200
Practice Address - Fax:817-332-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8495207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80F427Medicare ID - Type Unspecified
TXC16261Medicare UPIN