Individual provider Active NPI

Colin Nicholas Grant, O.D,

  • Optometrist
  • Herndon, VA
National Provider Identifier
1508207572
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618002269 Issued in VA
Practice address
709 Pine St
Herndon, VA 20170-4604
Phone
(703) 471-7810
Fax
(703) 471-6549
NPI assigned
Jul 8, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0618002269 VA Primary

Addresses

Primary practice location

709 Pine St
Herndon, VA 20170-4604

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130924000802 DC Practitioner - Optometry 8325282742 Reassigns benefits to 1 organization
I20220103001293 VA Practitioner - Optometry 8325282742 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
International American University at Puerto Rico - School of Optometry, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Virginia, PLLCGroup PAC ID 0143448456, 133 clinicians

Practice addresses (Care Compare)

10338 Bristow Ctr Dr
Bristow, VA 20136-2201
Phone (703) 392-1010

5809 Leesburg Pike
Falls Church, VA 22041-2301
Phone (866) 693-9336

709 Pine St
Herndon, VA 20170-4604
Phone (703) 471-7810

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0618002269VAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Virginia PLLC Optometrist Current Accepting new patients
Myeyedr Optometry of Virginia, PLLC Optometrist Current Accepting new patients
Myeyedr Optometry of Virginia, PLLC Optometrist CurrentSince Dec 31, 2021 Accepting new patients
Myeyedr Optometry of Virginia, PLLC Optometrist CurrentSince Dec 31, 2021 Accepting new patients
Myeyedr Optometry of Virginia, PLLC Optometrist CurrentSince Dec 31, 2021 Accepting new patients
Myeyedr Optometry of Virginia, PLLC Optometrist Past Accepting new patients

Locations

44727 Brimfield Dr
Ashburn, VA 20147
Phone (571) 385-4600

10338 Bristow Center Dr
Bristow, VA 20136
Phone (703) 392-1010

5809 Leesburg Pike
Falls Church, VA 22041
Phone (866) 693-9336

709 Pine St
Herndon, VA 20170
Phone (703) 471-7810

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1508207572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 PINE ST",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704604",
            "telephone_number": "703-471-7810",
            "fax_number": "703-471-6549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "COLIN",
        "middle_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "O.D,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-08",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618002269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Herndon, VA

Sources for this page

Verify at the official NPI Registry.