Provider Demographics
NPI:1417033861
Name:MARK V GRAYTOK
Entity Type:Organization
Organization Name:MARK V GRAYTOK
Other - Org Name:GRAYTOK FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:GRAYTOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-834-8033
Mailing Address - Street 1:235 HUMPHREY RD
Mailing Address - Street 2:TWO PINEVIEW PLACE, SUITE 1
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4579
Mailing Address - Country:US
Mailing Address - Phone:724-834-8033
Mailing Address - Fax:724-834-4290
Practice Address - Street 1:235 HUMPHREY RD
Practice Address - Street 2:TWO PINEVIEW PLACE, SUITE 1
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4579
Practice Address - Country:US
Practice Address - Phone:724-834-8033
Practice Address - Fax:724-834-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1119480002OtherNHIC, CORP; DME MAC JURISDICTION A
PA410012718OtherRAILROAD MEDICARE
PA1119480002Medicare NSC
594355Medicare ID - Type Unspecified