MEDICARE: ROBERT A GRACEY OD PC

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	332H00000X	Eyewear Supplier	3471TG	TX
2	152W00000X	Optometrist	3471TG	TX

General Provider Information

NPI Number	:	1225210032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT A GRACEY OD PC

Provider Business Mailing Address
First Line	:	1607 W HENDERSON ST
Second Line	:
City	:	CLEBURNE
State	:	TX
Zip	:	76033-4188
Country	:	US
Telephone Number	:	817-645-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 W HENDERSON ST
Second Line	:
City	:	CLEBURNE
State	:	TX
Zip	:	76033-4188
Country	:	US
Telephone Number	:	817-645-7733
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT A GRACEY
Credential	:	OD
Telephone Number	:	817-645-7733

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	07/15/2008

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