Healthcare Provider Details

I. General information

NPI: 1730409962
Provider Name (Legal Business Name): ROBERT F GRAY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 E 200 S STE 9
LEHI UT
84043-2291
US

IV. Provider business mailing address

785 E 200 S STE 9
LEHI UT
84043-2291
US

V. Phone/Fax

Practice location:
  • Phone: 801-768-4100
  • Fax: 801-768-0600
Mailing address:
  • Phone: 801-768-4100
  • Fax: 801-768-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number113649-9934
License Number StateUT

VIII. Authorized Official

Name: ROBERT F GRAY
Title or Position: PRESIDENT
Credential: OD
Phone: 801-768-4100