Provider Demographics
NPI:1326149717
Name:GRAU, GAIL JOHNSON (OD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:JOHNSON
Last Name:GRAU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:699 MCBROOM ST NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2511
Mailing Address - Country:US
Mailing Address - Phone:276-628-1143
Mailing Address - Fax:276-628-9522
Practice Address - Street 1:699 MCBROOM ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2511
Practice Address - Country:US
Practice Address - Phone:276-628-1143
Practice Address - Fax:276-628-9522
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618000166152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009205144Medicaid
VACA3685OtherPALMETTO GBA RAILROAD MEDIARE
VAVAA103644Medicare PIN
VAT21572Medicare UPIN
VA009205144Medicaid