Provider Demographics
NPI:1386643344
Name:MCGREW, GREG WESLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:WESLEY
Last Name:MCGREW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:12 FAIRFAX ST SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3616
Mailing Address - Country:US
Mailing Address - Phone:703-777-1299
Mailing Address - Fax:703-777-5645
Practice Address - Street 1:12 FAIRFAX ST SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3616
Practice Address - Country:US
Practice Address - Phone:703-777-1299
Practice Address - Fax:703-777-5645
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009236597Medicaid
VA410001291Medicare PIN