Provider Demographics
NPI:1891808812
Name:GRANT, JOSEPH J (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:GRANT
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 1:159 SAMOSET ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4815
Mailing Address - Country:US
Mailing Address - Phone:508-746-1990
Mailing Address - Fax:508-746-2093
Practice Address - Street 1:159 SAMOSET ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4815
Practice Address - Country:US
Practice Address - Phone:508-746-1990
Practice Address - Fax:508-746-2093
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0338605Medicaid
MAT59270Medicare UPIN
MA0338605Medicaid
MA182558Medicare PIN