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General NPI Number Information
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NPI Number | 1063014173
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Entity Type | Individual
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Provider Name | WRAY ROBERT WOELFEL OD
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Gender | Male
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 2546 RIMROCK AVE STE 100-B
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-8671
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Country | US
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Telephone | 970-208-1032
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Fax |
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Provider Business Mailing Address
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Address Line | 247 S KERSEY RD
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City | KERSEY
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State | PA
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Zip | 15846-2229
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Country | US
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Telephone | 814-594-7887
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT.0003635
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License Number State | CO
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