MEDICARE: HAROLD GRANEK MDPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	F8495	TX

General Provider Information

NPI Number	:	1528009214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAROLD GRANEK MDPA

Provider Business Mailing Address
First Line	:	1021 WASHINGTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3021
Country	:	US
Telephone Number	:	817-332-6200
Fax Number	:	817-332-8730

Provider Business Practice Location Address
First Line	:	1021 WASHINGTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3021
Country	:	US
Telephone Number	:	817-332-6200
Fax Number	:	817-332-8730

Authorized Official
Title or Position	:	CEO
Name	:	DR. HAROLD GRANEK
Credential	:	MD
Telephone Number	:	817-332-6200

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	08/22/2020

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