Healthcare Provider Details

I. General information

NPI: 1104912948
Provider Name (Legal Business Name): VINCENT B GRANIERO O D PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MIRACLE MILE DR
ROCHESTER NY
14623-5864
US

IV. Provider business mailing address

2089 KENYON ROAD
ONTARIO NY
14519-9750
US

V. Phone/Fax

Practice location:
  • Phone: 585-427-7960
  • Fax: 585-427-0451
Mailing address:
  • Phone: 315-524-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberVUT005266
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUT005266
License Number StateNY

VIII. Authorized Official

Name: DR. VINCENT B GRANIERO
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 585-427-7960