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General NPI Number Information
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NPI Number | 1417165028
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Entity Type | Individual
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Provider Name | GRAY ROBERT SMITH O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 2250 E HIGHWAY 50 SUITE 1
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City | CLERMONT
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State | FL
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Zip | 34711-6052
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Country | US
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Telephone | 352-243-5349
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Fax | 352-243-8358
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Provider Business Mailing Address
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Address Line | 2250 E HIGHWAY 50 SUITE 1
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City | CLERMONT
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State | FL
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Zip | 34711-6052
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Country | US
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Telephone | 352-243-5349
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Fax | 352-243-8358
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPC3661
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License Number State | FL
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