Provider Demographics
NPI:1073579884
Name:GRAYSON, REID L (OD)
Entity Type:Individual
Prefix:MR
First Name:REID
Middle Name:L
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 B PEARL STREET
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452
Mailing Address - Country:US
Mailing Address - Phone:802-878-5509
Mailing Address - Fax:802-879-1350
Practice Address - Street 1:230 COLLEGE STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-658-3330
Practice Address - Fax:802-658-7464
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0300000156152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT7950Medicaid
VTVT7950Medicaid
T25384Medicare UPIN