Healthcare Provider Details

I. General information

NPI: 1275973125
Provider Name (Legal Business Name): DR. JAMES K GRANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7367 TWO NOTCH RD
COLUMBIA SC
29223-7619
US

IV. Provider business mailing address

200 ROLLING KNOLL DR
COLUMBIA SC
29229-9274
US

V. Phone/Fax

Practice location:
  • Phone: 803-781-2123
  • Fax: 803-749-0183
Mailing address:
  • Phone: 803-781-2123
  • Fax: 803-749-0183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1752
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: