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General NPI Number Information
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NPI Number | 1104912948
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Entity Type | Organization
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Legal Business Name | VINCENT B GRANIERO O D PC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 121 MIRACLE MILE DR
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City | ROCHESTER
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State | NY
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Zip | 14623-5864
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Country | US
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Telephone | 585-427-7960
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Fax | 585-427-0451
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Provider Business Mailing Address
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Address Line | 2089 KENYON ROAD
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City | ONTARIO
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State | NY
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Zip | 14519-9750
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Country | US
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Telephone | 315-524-2040
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. VINCENT B GRANIERO
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Credential | O.D.
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Telephone | 585-427-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | VUT005266
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | VUT005266
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License Number State | NY
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