Provider Demographics
NPI:1790032290
Name:VISIONARY EYE CARE, L.L.C.
Entity Type:Organization
Organization Name:VISIONARY EYE CARE, L.L.C.
Other - Org Name:VISIONARY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRANEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-363-0060
Mailing Address - Street 1:10995 OWINGS MILLS BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1030
Mailing Address - Country:US
Mailing Address - Phone:410-363-0060
Mailing Address - Fax:410-363-0911
Practice Address - Street 1:10995 OWINGS MILLS BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1030
Practice Address - Country:US
Practice Address - Phone:410-363-0060
Practice Address - Fax:410-363-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA-1751152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty