Provider Demographics
NPI:1437463262
Name:BRAY, WILLAM EATL JR (CPO)
Entity Type:Individual
Prefix:MR
First Name:WILLAM
Middle Name:EATL
Last Name:BRAY
Suffix:JR
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42502-1323
Mailing Address - Country:US
Mailing Address - Phone:606-451-0668
Mailing Address - Fax:
Practice Address - Street 1:310 LANGDON ST STE 2
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2795
Practice Address - Country:US
Practice Address - Phone:606-451-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier