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NPI Code Detail

MEDICARE: DANIEL GRAY OD

MEDICARE:   DANIEL  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
1152W00000XOptometrist1861NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00010416OTHERNCRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2133PTOTHERNCBLUECROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366435729
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL GRAY OD
Provider Business Mailing Address
First Line : 7100 SIX FORKS RD
Second Line : SUITE 301
City : RALEIGH
State : NC
Zip : 27615-6156
Country : US
Telephone Number : 919-847-0187
Fax Number : 919-676-2231
Provider Business Practice Location Address
First Line : 1975 HIGH HOUSE RD
Second Line :
City : CARY
State : NC
Zip : 27519-8452
Country : US
Telephone Number : 919-461-0771
Fax Number : 919-481-0645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 02/12/2013

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