Garry D Grant, MD
Individual provider Active NPI Retina Specialist (Ophthalmology) Physician · Eureka, MT
NPI 1962497677 · NPPES record last updated Nov 18, 2022
Key facts
- NPI
- 1962497677
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Retina Specialist (Ophthalmology) Physician 207WX0107X
- License
- MED-PHYS-LIC-57501 (MT)
- Practice address
- 2055 Mud Creek Rd
Eureka, MT 59917-9070 - Phone
- (812) 424-2020
- Fax
- (812) 424-3000
- NPI assigned
- Sep 19, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MED-PHYS-LIC-57501 | MT | MD | Retina Specialist (Ophthalmology) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Retina Specialist (Ophthalmology) Physician | 207WX0107X | MED-PHYS-LIC-57501 | MT | Yes |
Addresses
Primary practice location
2055 Mud Creek Rd
Eureka, MT 59917-9070
Mailing address
PO Box 2450
Eureka, MT 59917-2450
Phone (812) 204-1703
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000042320 | Other | ANTHEM | |
| 64878010 | Medicaid | KY | |
| 200000980 | Medicaid | IN | |
| 259157 | Other | HEALTHLINK | |
| 4500741 | Other | AETNA |
Other providers in Eureka, MT
- Mark A. Fink
- Rod Eugene Fleming
- Carl William Florey
- Gateway Freedom Ranch
- Glacier Clinic LLC
- Tammi Green
- Tiffany Gregg
- Grizzly Eye Center, PC
- Frank Robin Haidle
- Haines Drug Eureka, Inc.
All providers in Eureka, MT · Retina Specialist (Ophthalmology) Physician in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.