Provider Demographics
NPI:1366504839
Name:RAY, ADRIENNE R (OD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:R
Last Name:RAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ADRIENNE
Other - Middle Name:R
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8107 CARRIAGE XING
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3265
Mailing Address - Country:US
Mailing Address - Phone:334-201-7226
Mailing Address - Fax:
Practice Address - Street 1:7200 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2671
Practice Address - Country:US
Practice Address - Phone:423-499-0810
Practice Address - Fax:423-805-7338
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000003441152W00000X
GAOPT001886152W00000X
ALS-956-TA-546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL52212290Medicaid
ALU86720Medicare UPIN