Provider Demographics
NPI:1023907060
Name:GRAY, RALEY NICOLE (OD)
Entity type:Individual
Prefix:
First Name:RALEY
Middle Name:NICOLE
Last Name:GRAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RALEY
Other - Middle Name:NICOLE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15641 VACCA WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-1429
Mailing Address - Country:US
Mailing Address - Phone:817-368-9383
Mailing Address - Fax:
Practice Address - Street 1:3451 WESTERN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-3101
Practice Address - Country:US
Practice Address - Phone:817-382-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11467152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist