Healthcare Provider Details

I. General information

NPI: 1851329544
Provider Name (Legal Business Name): ROBIN LYNN GRAY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 BLACK HORSE PIKE
PLEASANTVILLE NJ
08232-4129
US

IV. Provider business mailing address

108 HOLLY LN
LINWOOD NJ
08221-2257
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-4722
  • Fax:
Mailing address:
  • Phone: 609-927-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOA04027 TO00250
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: