Provider Demographics
NPI:1538245162
Name:GRANITE POINTE EYE CARE, INC.
Entity type:Organization
Organization Name:GRANITE POINTE EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OKAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-797-6747
Mailing Address - Street 1:9221 SIERRA COLLEGE BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5919
Mailing Address - Country:US
Mailing Address - Phone:916-797-6747
Mailing Address - Fax:916-797-6728
Practice Address - Street 1:9221 SIERRA COLLEGE BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5919
Practice Address - Country:US
Practice Address - Phone:916-797-6747
Practice Address - Fax:916-797-6728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9831152WC0802X, 152WP0200X, 152WS0006X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD005440Medicaid
CAZZZ27265ZMedicare ID - Type UnspecifiedGROUP #
CAU77101Medicare UPIN
CA5002670001Medicare NSC
CASD0098311Medicare ID - Type UnspecifiedPPIN#