Provider Demographics
NPI:1710147079
Name:GRANT VISION CARE
Entity Type:Organization
Organization Name:GRANT VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DRUSILLA
Authorized Official - Middle Name:HASKINS
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-923-9951
Mailing Address - Street 1:1520 PORTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-2121
Mailing Address - Country:US
Mailing Address - Phone:330-923-9951
Mailing Address - Fax:330-923-6419
Practice Address - Street 1:1520 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2121
Practice Address - Country:US
Practice Address - Phone:330-923-9951
Practice Address - Fax:330-923-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3533T464332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0618690001Medicare NSC
OHT47436Medicare UPIN