Provider Demographics
NPI:1679187306
Name:MCPHERON, GRANT (OD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
Last Name:MCPHERON
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:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:IA
Mailing Address - Zip Code:52645-0159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:IA
Practice Address - Zip Code:52645-1335
Practice Address - Country:US
Practice Address - Phone:319-367-5313
Practice Address - Fax:319-367-0220
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist