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General NPI Number Information
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NPI Number | 1134258080
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Entity Type | Organization
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Legal Business Name | OPTICS UNIQUE
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 3500 N MIDKIFF RD SUITE 100
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City | MIDLAND
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State | TX
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Zip | 79705-4834
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Country | US
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Telephone | 432-699-1300
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Fax | 432-694-1981
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Provider Business Mailing Address
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Address Line | 3500 N MIDKIFF RD SUITE 100
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City | MIDLAND
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State | TX
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Zip | 79705-4834
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Country | US
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Telephone | 432-699-1300
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Fax | 432-694-1981
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID GRAY
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Credential | O.D.
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Telephone | 432-699-1300
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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 | 6216TG
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License Number State | TX
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