1144213083 NPI number — EDWARD H GRATTAN OD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144213083 NPI number — EDWARD H GRATTAN OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD H GRATTAN OD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GRATTAN OPTOMETRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144213083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 W WASHINGTON ST
Provider Second Line Business Mailing Address:
STE 7
Provider Business Mailing Address City Name:
CLARKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48346-1572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-625-3500
Provider Business Mailing Address Fax Number:
248-625-0025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
CLARKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48346-1572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-625-3500
Provider Business Practice Location Address Fax Number:
248-625-0025
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRATTAN
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
OPTOMETRIST OWNER
Authorized Official Telephone Number:
248-625-3500

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901002202 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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