Grant Robert Smith, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2211 Issued in MN

Practice address

4190 Vinewood LN N
Suite 109
Plymouth, MN 55442-1735

Phone

(763) 559-5522

Fax

(763) 559-7122

NPI assigned

Nov 16, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750454906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13345 32ND AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412635",
            "telephone_number": "763-383-0484",
            "fax_number": "763-383-0486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 VINEWOOD LN N",
            "address_2": "SUITE 109",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554421735",
            "telephone_number": "763-559-5522",
            "fax_number": "763-559-7122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GRANT",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Smile Design Dentistry, PLLC
• Megan Smith-Cannistraci, PT
• Anna C Smith, MA LADC
• Annalyn Smith, M.A, CCC-SLP
• Gina Smith
• Jennifer Smith, COTA
• Jessica Peckham Smith
• Michael Smith, ATC
• Maria Katherine Smothers
• Daniel Chadbourn Sneeden, PHARMD

• Optometrist in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.