Provider Demographics
NPI:1033257019
Name:GRAY, HARRY EDWARD III (OD, PHD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:EDWARD
Last Name:GRAY
Suffix:III
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 LOWRIE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1272
Mailing Address - Country:US
Mailing Address - Phone:330-467-0255
Mailing Address - Fax:330-467-0255
Practice Address - Street 1:5100 GREAT NORTHERN MALL
Practice Address - Street 2:JC PENNEY OPTICAL
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3305
Practice Address - Country:US
Practice Address - Phone:440-779-8145
Practice Address - Fax:440-779-9118
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2274462Medicaid
OHGA4062091Medicare ID - Type Unspecified
OH2274462Medicaid