Organization
BSGI HOLDINGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY GRANT OD (MEMBER)
(901) 496-9129
Entity
Organization
Contact information
Practice address
2102 N PROSPECT AVE, CHAMPAIGN, IL 61822-1231
(217) 352-2468
Mailing address
1090 BUCKS POND RD, MONTICELLO, IL 61856-8058
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
08/04/2021
Last updated
08/04/2021
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