# BRYAN D GRANGER OD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154592947
- **Authorized official:** DR. BRYAN D GRANGER OD (PRESIDENT)
- **Authorized official phone:** (337) 364-0425

## Contact information

- **Practice address:** 1110 ANGERS ST, NEW IBERIA, LA 70563-2012
- **Practice address phone:** (337) 364-0425
- **Practice address fax:** (337) 364-0426
- **Mailing address:** 1110 ANGERS ST, NEW IBERIA, LA 70563-2012
- **Mailing address phone:** (337) 364-0425
- **Mailing address fax:** (337) 364-0426

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 1366-535T | LA | Yes |

## Other

- **Enumeration date:** 03/19/2008
- **Last updated:** 10/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1621579 | — | LA |