Provider Demographics
NPI:1548404783
Name:GRAY, WILLIAM D (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:GRAY
Suffix:
Gender:M
Credentials:OPTICIAN
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 973
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-0973
Mailing Address - Country:US
Mailing Address - Phone:301-672-0315
Mailing Address - Fax:
Practice Address - Street 1:3005 LEONARDTOWN RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3136
Practice Address - Country:US
Practice Address - Phone:301-645-6550
Practice Address - Fax:301-645-6699
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician