Provider Demographics
NPI:1992791289
Name:GRANADO-CHANEY, REEDEE (OD)
Entity type:Individual
Prefix:DR
First Name:REEDEE
Middle Name:
Last Name:GRANADO-CHANEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:REEDEE
Other - Middle Name:
Other - Last Name:GRANADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2600 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3700
Practice Address - Country:US
Practice Address - Phone:817-571-6688
Practice Address - Fax:817-571-6906
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2020-11-24
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
TX6506TG152WC0802X, 152WP0200X, 152WS0006X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F10258Medicare PIN
TX0A3227Medicare PIN