Individual
GRANT MEANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
109 MEDICAL PARK LN, HUNTSVILLE, TX 77340-4977
(936) 291-8282
Mailing address
449 MARION LN, NEW WAVERLY, TX 77358-4505
(936) 661-2157
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11157T
TX
Other
Enumeration date
06/25/2024
Last updated
06/25/2024
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