Provider Demographics
NPI:1760654362
Name:GRANT EYEGLASSES INC.
Entity Type:Organization
Organization Name:GRANT EYEGLASSES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:239-334-7268
Mailing Address - Street 1:5248 BANK ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2111
Mailing Address - Country:US
Mailing Address - Phone:239-334-7268
Mailing Address - Fax:239-334-0844
Practice Address - Street 1:5248 BANK ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2111
Practice Address - Country:US
Practice Address - Phone:239-334-7268
Practice Address - Fax:239-334-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO2474332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0891700001Medicare PIN
0891700001Medicare NSC