Healthcare Provider Details

I. General information

NPI: 1538245162
Provider Name (Legal Business Name): GRANITE POINTE EYE CARE, INC., AN OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 SIERRA COLLEGE BLVD SUITE 130
ROSEVILLE CA
95661-5919
US

IV. Provider business mailing address

9221 SIERRA COLLEGE BLVD STE 130
ROSEVILLE CA
95661-5934
US

V. Phone/Fax

Practice location:
  • Phone: 916-797-6747
  • Fax: 916-797-6728
Mailing address:
  • Phone: 916-797-6747
  • Fax: 916-797-6728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9831
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number9831
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number9831
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number9831
License Number StateCA

VIII. Authorized Official

Name: TAMI BLISS
Title or Position: MANAGER
Credential:
Phone: 916-838-5532