Provider Demographics
NPI:1447668280
Name:GRANGE, MARGARET (OD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:GRANGE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 FARNAM ST
Mailing Address - Street 2:315
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-5004
Mailing Address - Country:US
Mailing Address - Phone:402-321-5028
Mailing Address - Fax:
Practice Address - Street 1:1103 GALVIN RD S
Practice Address - Street 2:H
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3004
Practice Address - Country:US
Practice Address - Phone:402-292-6514
Practice Address - Fax:402-292-7122
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist