Healthcare Provider Details

I. General information

NPI: 1467360495
Provider Name (Legal Business Name): GRANT OPTOMETRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 EGLIN ST
RAPID CITY SD
57701-9567
US

IV. Provider business mailing address

1 VERMONT DR
NEW HYDE PARK NY
11042-1128
US

V. Phone/Fax

Practice location:
  • Phone: 605-877-3051
  • Fax:
Mailing address:
  • Phone: 516-243-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUSAN CHRISTOPHER-BRAND
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 380-223-3412