Individual
DR. GRANT ROBERT SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4190 VINEWOOD LN N, SUITE 109, PLYMOUTH, MN 55442-1735
(763) 559-5522
(763) 559-7122
Mailing address
13345 32ND AVE N, PLYMOUTH, MN 55441-2635
(763) 383-0484
(763) 383-0486
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2211
MN
Other
Enumeration date
11/16/2006
Last updated
07/08/2007
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