Provider Demographics
NPI:1144428491
Name:GRAY, TAMMY JEAN (OD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:JEAN
Last Name:GRAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4999 E KENTUCKY AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2281
Mailing Address - Country:US
Mailing Address - Phone:303-691-2228
Mailing Address - Fax:303-759-9052
Practice Address - Street 1:4999 E KENTUCKY AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3901
Practice Address - Country:US
Practice Address - Phone:303-691-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV573152W00000X
CO2558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA2507OtherMEDICARE PTAN