Provider Demographics
NPI:1609813666
Name:GRAY, ANGELA B (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:B
Last Name:GRAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CAMPEN RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-1597
Mailing Address - Country:US
Mailing Address - Phone:252-838-8822
Mailing Address - Fax:
Practice Address - Street 1:300 CAMPEN RD
Practice Address - Street 2:SUITE A
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-1597
Practice Address - Country:US
Practice Address - Phone:252-838-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0917GOtherBCBSNC INDIVIDUAL NUMBER
NC890917GMedicaid
NC0917GOtherBCBSNC INDIVIDUAL NUMBER
NC890917GMedicaid