Provider Demographics
NPI:1104912948
Name:VINCENT B GRANIERO O D PC
Entity type:Organization
Organization Name:VINCENT B GRANIERO O D PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRANIERO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-427-7960
Mailing Address - Street 1:2089 KENYON ROAD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9750
Mailing Address - Country:US
Mailing Address - Phone:315-524-2040
Mailing Address - Fax:
Practice Address - Street 1:121 MIRACLE MILE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5864
Practice Address - Country:US
Practice Address - Phone:585-427-7960
Practice Address - Fax:585-427-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005266332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG0187022590OtherBLUE CHOICE
NY11850AMedicare PIN