MEDICARE: RALEY NICOLE GRAY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	11467	TX

General Provider Information

NPI Number	:	1023907060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALEY NICOLE GRAY OD

Provider Business Mailing Address
First Line	:	15641 VACCA WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1429
Country	:	US
Telephone Number	:	817-368-9383
Fax Number	:

Provider Business Practice Location Address
First Line	:	3451 WESTERN CENTER BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-3101
Country	:	US
Telephone Number	:	817-382-3012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	07/02/2025

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