Provider Demographics
NPI:1609865146
Name:GRAD, HOWARD STEVEN (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:STEVEN
Last Name:GRAD
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 1:122 E CENTER ST
Mailing Address - Street 2:STE B
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5265
Mailing Address - Country:US
Mailing Address - Phone:860-646-3933
Mailing Address - Fax:860-432-1116
Practice Address - Street 1:122 E CENTER ST
Practice Address - Street 2:STE B
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5265
Practice Address - Country:US
Practice Address - Phone:860-646-3933
Practice Address - Fax:860-432-1116
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT766152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004024204Medicaid
CT0137230001Medicare NSC
410000249Medicare PIN
CT004024204Medicaid