Provider Demographics
NPI:1831936673
Name:GOSSARD, GRANT GOSSARD FRANKLIN (OD)
Entity type:Individual
Prefix:
First Name:GRANT GOSSARD
Middle Name:FRANKLIN
Last Name:GOSSARD
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 1:5606 JEFFRIES CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8013
Mailing Address - Country:US
Mailing Address - Phone:614-648-1487
Mailing Address - Fax:
Practice Address - Street 1:5606 JEFFRIES CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8013
Practice Address - Country:US
Practice Address - Phone:614-648-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist