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General NPI Number Information
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NPI Number | 1740583442
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Entity Type | Individual
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Provider Name | ANDREA KAY SMITH-GRAY O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/19/2010
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 419 W REDWOOD ST
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City | BALTIMORE
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State | MD
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Zip | 21201-1734
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Country | US
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Telephone | 667-214-2005
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Fax | 410-328-8327
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Provider Business Mailing Address
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Address Line | 419 W REDWOOD ST
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City | BALTIMORE
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State | MD
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Zip | 21201-1734
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Country | US
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Telephone | 667-214-2005
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Fax | 410-328-8327
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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 | TA2874
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License Number State | MD
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