Provider Demographics
NPI:1518043348
Name:J BRIAN GRAY OD PA
Entity Type:Organization
Organization Name:J BRIAN GRAY OD PA
Other - Org Name:GRAY VISION HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-935-5454
Mailing Address - Street 1:114 E OAK AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3561
Mailing Address - Country:US
Mailing Address - Phone:870-935-5454
Mailing Address - Fax:870-935-2643
Practice Address - Street 1:114 E OAK AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3561
Practice Address - Country:US
Practice Address - Phone:870-935-5454
Practice Address - Fax:870-935-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2414152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR42186OtherDAVIS VISION
AR149197722Medicaid
AR12189OtherSPECTERA
AR123724722Medicaid
AR48741OtherINDIVIDUAL BCBS
AR207398OtherEYEMED
AR=========OtherVBA
AR123724722Medicaid
AR149197722Medicaid
AR=========OtherVCA
AR149197722Medicaid
AR42186OtherDAVIS VISION