MEDICARE: DANIEL P GRAY O.D.

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	0618001427	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194721449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL P GRAY O.D.

Provider Business Mailing Address
First Line	:	5644 BROOK RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-2273
Country	:	US
Telephone Number	:	804-264-2956
Fax Number	:	804-264-2956

Provider Business Practice Location Address
First Line	:	9335 CHAMBERLAYNE RD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2805
Country	:	US
Telephone Number	:	804-264-2956
Fax Number	:	804-264-0447

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/01/2023

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