Provider Demographics
NPI:1508940065
Name:VANRAY, WILLS (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLS
Middle Name:
Last Name:VANRAY
Suffix:
Gender:M
Credentials:OD
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 2804
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-2804
Mailing Address - Country:US
Mailing Address - Phone:970-468-0389
Mailing Address - Fax:970-468-4790
Practice Address - Street 1:325 LAKE DILLON DRIVE, SUITE 104
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-2804
Practice Address - Country:US
Practice Address - Phone:970-468-0389
Practice Address - Fax:970-468-4790
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83357033Medicaid
AZ149736Medicaid
CO31528546Medicaid
AZ149736Medicaid
NM83357033Medicaid
NMV10688Medicare UPIN
NM320059Medicare Oscar/Certification