Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TA1751 | MD |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | TA-1751 | MD |
NPI | 1124027248 |
---|---|
Provider Name | Dr. Brian Michael Granek |
First Address | Owings Mills, MD 21117-1030 |
Second Address | Owings Mills, MD 21117-1030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 17/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U92682 | (02) | MD |