Provider Demographics
NPI:1881675270
Name:GRANDAS, MARK A (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:GRANDAS
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 1:1018 N GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-2026
Mailing Address - Country:US
Mailing Address - Phone:717-848-1316
Mailing Address - Fax:717-846-5440
Practice Address - Street 1:1018 N GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-2026
Practice Address - Country:US
Practice Address - Phone:717-848-1316
Practice Address - Fax:717-846-5440
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01974483Medicaid
PA01974483Medicaid
PA062711Medicare PIN