Basic Information
| Provider Information | |||||||||
| NPI: | 1811419237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANNER | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | JADE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 BURLINGTON MALL RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815051995 | ||||||||
| FaxNumber: | 7815051998 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 BURLINGTON MALL RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815051995 | ||||||||
| FaxNumber: | 7815051998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2017 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5228 | MA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.