Granger Optical LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

5816072 Issued in UT

Legal business name

GRANGER OPTICAL LLC

Practice address

3725 W 4100 S
West Valley City, UT 84120-5530

Phone

(801) 965-3636

Fax

(801) 965-3559

NPI assigned

Sep 6, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert E Smith, M.D.

Title

Owner

Phone

(801) 965-3636

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adam B Petersen, AA

  • Anesthesiologist Assistant
  • Springfield, MO
  • NPI 1518216613
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750484945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3725 W 4100 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841205530",
            "telephone_number": "801-965-3636",
            "fax_number": "801-965-3559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3725 W 4100 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841205530",
            "telephone_number": "801-965-3636",
            "fax_number": "801-965-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGER OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-965-3636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "UT",
            "license": "5816072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "OP1812",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Granger Clinic Pharmacy Inc
• Granger Medical Clinic (Jon Richard Aoki)
• Granger Medical Clinic PC
• Granger Medical Clinic, PC
• Granger Medical Specialists LLC
• Granger Pediatric Dentistry
• Granger Pharmacy
• Granger Pharmacy (Granger Pharmacy,LLC)
• Adam Adair Green, MFTI
• Annalisa Gregory, CSW

• Eyewear Supplier in West Valley City, UT
• Providers in West Valley City, UT by specialty
• Eyewear Supplier in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.