Provider Demographics
NPI:1639566078
Name:GRANADOS, JEFFREY-JONATHAN OCFEMIA (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY-JONATHAN
Middle Name:OCFEMIA
Last Name:GRANADOS
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 1:1733 KATHLEEN CT
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2337
Mailing Address - Country:US
Mailing Address - Phone:626-825-8493
Mailing Address - Fax:
Practice Address - Street 1:1733 KATHLEEN CT
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-2337
Practice Address - Country:US
Practice Address - Phone:626-825-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14888 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist