Provider Demographics
NPI:1275812075
Name:GREG RAY, O.D., INC
Entity Type:Organization
Organization Name:GREG RAY, O.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-906-4446
Mailing Address - Street 1:3050 WILMA RUDOLPH BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5031
Mailing Address - Country:US
Mailing Address - Phone:931-906-4446
Mailing Address - Fax:931-906-8544
Practice Address - Street 1:3050 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5031
Practice Address - Country:US
Practice Address - Phone:931-906-4446
Practice Address - Fax:931-906-8544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU29080Medicare UPIN
TN3597185Medicare PIN