Active NPI
Stanley Chase Grandon, M.D.
- Ophthalmology Physician
- Dearborn, MI
National Provider Identifier
1013956556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- SG030076
- Practice address
- 15212 Michigan Ave
Dearborn, MI 48126-3497 - Phone
- (313) 582-8856
- Fax
- (313) 582-8265
- NPI assigned
- Jun 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | SG030076 | MI | Primary |
Addresses
Primary practice location
15212 Michigan Ave
Dearborn, MI 48126-3497
Mailing address
15212 Michigan Ave
Dearborn, MI 48126-3497
Phone (313) 582-8856
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1382517 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SG030076 | MI | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192406400000",
"number": "1013956556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15212 MICHIGAN AVE",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481263497",
"telephone_number": "313-582-8856",
"fax_number": "313-582-8265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15212 MICHIGAN AVE",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481263497",
"telephone_number": "313-582-8856",
"fax_number": "313-582-8265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANDON",
"first_name": "STANLEY",
"middle_name": "CHASE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2007-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MI",
"license": "SG030076",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1382517",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.