Healthcare Provider Details

I. General information

NPI: 1801172259
Provider Name (Legal Business Name): AIMEE K. GRAY, OD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300A FAUNCE CORNER RD SUITE 101
NORTH DARTMOUTH MA
02747-1280
US

IV. Provider business mailing address

300A FAUNCE CORNER RD SUITE 101
NORTH DARTMOUTH MA
02747-1280
US

V. Phone/Fax

Practice location:
  • Phone: 508-994-8092
  • Fax:
Mailing address:
  • Phone: 508-995-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4197
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number4197
License Number StateMA

VIII. Authorized Official

Name: DR. AIMEE GRAY PICKETT
Title or Position: OWNER
Credential: OD
Phone: 508-994-8092