Provider Demographics
NPI:1629380977
Name:GRANNIS, CHARITY HALPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:HALPHEN
Last Name:GRANNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 GRAMERCY ST # 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1697
Mailing Address - Country:US
Mailing Address - Phone:713-668-6828
Mailing Address - Fax:
Practice Address - Street 1:2855 GRAMERCY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1756
Practice Address - Country:US
Practice Address - Phone:713-668-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0056207WX0110X, 207W00000X
TXBP20041197207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350244502Medicaid