MEDICARE: DR. DAVID GRAY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6216TG	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00033777	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	80898Q	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1063425569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID GRAY O.D.

Provider Business Mailing Address
First Line	:	3500 N MIDKIFF RD
Second Line	:	STE100
City	:	MIDLAND
State	:	TX
Zip	:	79705-4834
Country	:	US
Telephone Number	:	432-699-1300
Fax Number	:	432-694-1981

Provider Business Practice Location Address
First Line	:	3500 N MIDKIFF RD
Second Line	:	SUITE 100
City	:	MIDLAND
State	:	TX
Zip	:	79705-4834
Country	:	US
Telephone Number	:	432-699-1300
Fax Number	:	432-694-1981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	02/17/2010

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