Active NPI
Jefferson Grant Jr., LDO
- Optician
- Greenville, SC
National Provider Identifier
1245960202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 798
- Practice address
- 3925 Pelham Rd
Greenville, SC 29615-5004 - Phone
- (864) 288-2813
- Fax
- (864) 288-2820
- NPI assigned
- Jun 13, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 798 | SC | Primary |
Addresses
Primary practice location
3925 Pelham Rd
Greenville, SC 29615-5004
Mailing address
3925 Pelham Rd
Greenville, SC 29615-5004
Phone (864) 288-2813
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 798 | SC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655078400000",
"number": "1245960202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3925 PELHAM RD",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296155004",
"telephone_number": "864-288-2813",
"fax_number": "864-288-2820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3925 PELHAM RD",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296155004",
"telephone_number": "864-288-2813",
"fax_number": "864-288-2820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "JEFFERSON",
"name_suffix": "Jr.",
"credential": "LDO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-13",
"last_updated": "2022-06-13",
"certification_date": "2022-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "SC",
"license": "798",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
- Christopher Paul Grandits, PHD
- Grandmas Helping Hands (Home healthcare)
- Jacqueline Joyce Peebles Granger, M.D.
- Meghan Barnes Granger, BCBA
- Heidi Gramling Grant, OTR/L
- Lawrence Dale Grant, MD
- Louise Lochrane Grant, M.D.
- Randy Coonfield Grant, LISW-CP
- Wilease Carletta Grant, MASTER DEGREE IN REH
- Margaret Grappone
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.