Provider Demographics
NPI:1760889968
Name:GRANDY, WILLIAM JR
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:GRANDY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-4217
Mailing Address - Country:US
Mailing Address - Phone:561-585-6472
Mailing Address - Fax:561-533-5773
Practice Address - Street 1:6301 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-4217
Practice Address - Country:US
Practice Address - Phone:561-585-6472
Practice Address - Fax:561-533-5773
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician