Individual
DR. J GRADY ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1456
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0112W
BCBS
NC
01
—
0247000001
PALMETTO GBA
NC
05
—
890908B
—
NC
Enumeration date
02/08/2007
Last updated
04/13/2011
Update your record
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