Individual provider · NPI-1

Dr. Reginald Dean Grandison, O.D.

Optometrist · Southfield, MI

NPI number1790723609
StatusActive
Last updated in NPPESJan 3, 2008

Details

NPI
1790723609
Entity type
Individual (NPI-1)
Name
Dr. Reginald Dean Grandison
Credential
O.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Jun 3, 2006
Last updated
Jan 3, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X Optometrist4901003700MIYes

Practice location

23832 Southfield Rd
Southfield, MI 48075-8017

Phone 248-443-8089 · Fax 313-865-1867

Mailing address

23832 Southfield Rd
Southfield, MI 48075-8017

Phone 248-443-8089 · Fax 313-865-1867

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