Healthcare Provider Details

I. General information

NPI: 1073579884
Provider Name (Legal Business Name): REID L GRAYSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 COLLEGE STREET SUITE 1
BURLINGTON VT
05401
US

IV. Provider business mailing address

77 B PEARL STREET
ESSEX JUNCTION VT
05452
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-3330
  • Fax: 802-658-7464
Mailing address:
  • Phone: 802-878-5509
  • Fax: 802-879-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0300000156
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: