Provider Demographics
NPI:1831163484
Name:GRANIERO, VINCENT (OD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:GRANIERO
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 1:121 MIRACLE MILE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-5864
Mailing Address - Country:US
Mailing Address - Phone:585-427-7960
Mailing Address - Fax:
Practice Address - Street 1:121 MIRACLE MILE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5864
Practice Address - Country:US
Practice Address - Phone:585-427-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTOO5266152W00000X
NYVUT005266332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMDE316OtherPREFERRED CARE PRO. #
NYP010052661OtherBLUE CHOICE
NYU-21245Medicare UPIN
NY11850BMedicare PIN