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General NPI Number Information
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NPI Number | 1760654362
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Entity Type | Organization
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Legal Business Name | GRANT EYEGLASSES INC.
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 5248 BANK ST
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City | FORT MYERS
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State | FL
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Zip | 33907-2111
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Country | US
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Telephone | 239-334-7268
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Fax | 239-334-0844
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Provider Business Mailing Address
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Address Line | 5248 BANK ST
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City | FORT MYERS
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State | FL
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Zip | 33907-2111
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Country | US
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Telephone | 239-334-7268
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Fax | 239-334-0844
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES E. GRANT JR.
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Credential | OPTICIAN
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Telephone | 239-334-7268
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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 | DO2474
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License Number State | FL
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