Provider Demographics
NPI:1225210032
Name:ROBERT A GRACEY OD PC
Entity Type:Organization
Organization Name:ROBERT A GRACEY OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-645-7733
Mailing Address - Street 1:1607 W HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4188
Mailing Address - Country:US
Mailing Address - Phone:817-645-7733
Mailing Address - Fax:
Practice Address - Street 1:1607 W HENDERSON ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4188
Practice Address - Country:US
Practice Address - Phone:817-645-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3471TG152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4462290001Medicare NSC
00E19QMedicare PIN
T13531Medicare UPIN