MEDICARE: OPTICS UNIQUE

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	6216TG	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DA2147	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0099FC	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134258080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICS UNIQUE

Provider Business Mailing Address
First Line	:	3500 N MIDKIFF RD
Second Line	:	SUITE 100
City	:	MIDLAND
State	:	TX
Zip	:	79705-4834
Country	:	US
Telephone Number	:	432-699-1300
Fax Number	:	432-694-1981

Provider Business Practice Location Address
First Line	:	3500 N MIDKIFF RD
Second Line	:	SUITE 100
City	:	MIDLAND
State	:	TX
Zip	:	79705-4834
Country	:	US
Telephone Number	:	432-699-1300
Fax Number	:	432-694-1981

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID GRAY
Credential	:	O.D.
Telephone Number	:	432-699-1300

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	04/30/2008

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Directions to “OPTICS UNIQUE ” Practice Location

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