Provider Demographics
NPI:1609189612
Name:GRANT, BROOKS TRENT (OD)
Entity Type:Individual
Prefix:DR
First Name:BROOKS
Middle Name:TRENT
Last Name:GRANT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5920
Mailing Address - Country:US
Mailing Address - Phone:325-698-2010
Mailing Address - Fax:325-692-2025
Practice Address - Street 1:5550 S CLACK ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3708
Practice Address - Country:US
Practice Address - Phone:325-698-2010
Practice Address - Fax:325-692-2025
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7554T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist