Provider Demographics
NPI:1023031994
Name:CLAY, GREGORY B (OD,FAAO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
Last Name:CLAY
Suffix:
Gender:M
Credentials:OD,FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-1426
Mailing Address - Country:US
Mailing Address - Phone:580-920-2020
Mailing Address - Fax:580-924-5656
Practice Address - Street 1:1901 UNIVERSITY BLVD.
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2127
Practice Address - Country:US
Practice Address - Phone:580-920-2020
Practice Address - Fax:580-924-5656
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761430AMedicaid
OKT40395Medicare UPIN
OK100761430AMedicaid