Healthcare Provider Details

I. General information

NPI: 1225210032
Provider Name (Legal Business Name): ROBERT A GRACEY OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 W HENDERSON ST
CLEBURNE TX
76033-4188
US

IV. Provider business mailing address

1607 W HENDERSON ST
CLEBURNE TX
76033-4188
US

V. Phone/Fax

Practice location:
  • Phone: 817-645-7733
  • Fax:
Mailing address:
  • Phone: 817-645-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3471TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number3471TG
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERT A GRACEY
Title or Position: PRESIDENT
Credential: OD
Phone: 817-645-7733