Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D969 | NJ |
NPI | 1114098217 |
---|---|
Provider Name | Mr. Grant Louis Colgary JR. |
First Address | Morristown, NJ 07960-6392 |
Second Address | Morristown, NJ 07960-6392 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2006 |
Last Update Date | 08/07/2007 |