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Individual
NICOLA GRANGER
Active
Individual
NICOLA GRANGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 5177
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017822000
—
FL
01
—
IQ6502
MEDICARE PTAN
FL
Enumeration date
07/02/2015
Last updated
09/21/2021
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