MEDICARE: DIRK M GRAY OD

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	1088	NE
2	152W00000X	Optometrist	1529	KS

General Provider Information

NPI Number	:	1740269588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIRK M GRAY OD

Provider Business Mailing Address
First Line	:	PO BOX 1808
Second Line	:
City	:	MC COOK
State	:	NE
Zip	:	69001-1808
Country	:	US
Telephone Number	:	308-345-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 WEST D STREET
Second Line	:
City	:	MC COOK
State	:	NE
Zip	:	69001-3739
Country	:	US
Telephone Number	:	308-345-5800
Fax Number	:

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	02/06/2020

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Directions to “ DIRK M GRAY OD” Practice Location

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