Provider Demographics
NPI:1134469190
Name:BOBBY G RAY OD PA
Entity Type:Organization
Organization Name:BOBBY G RAY OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:432-695-6251
Mailing Address - Street 1:PO BOX 50247
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79710-0247
Mailing Address - Country:US
Mailing Address - Phone:432-695-6251
Mailing Address - Fax:432-224-1500
Practice Address - Street 1:4400 N MIDLAND DR STE 404
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3388
Practice Address - Country:US
Practice Address - Phone:432-695-6251
Practice Address - Fax:432-224-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2132TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010YHOtherBCBS
TX316066501Medicaid
TX0010YHOtherBCBS
T15448Medicare UPIN