Provider Demographics
NPI:1679658611
Name:JAMES EDWARD GRAU JR
Entity Type:Organization
Organization Name:JAMES EDWARD GRAU JR
Other - Org Name:DRS JAMES & GAIL GRAU OPTOMETRISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-628-1143
Mailing Address - Street 1:699 MCBROOM ST NW # A
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2511
Mailing Address - Country:US
Mailing Address - Phone:276-682-1143
Mailing Address - Fax:
Practice Address - Street 1:699 MCBROOM ST NW STE A
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2511
Practice Address - Country:US
Practice Address - Phone:276-628-1143
Practice Address - Fax:276-628-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000166152W00000X
VA0618000167152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009205136Medicaid
VA009205144Medicaid
VAT21572Medicare UPIN
VA009205144Medicaid
VA0717100002Medicare NSC
VA410000342Medicare ID - Type Unspecified
VAC01459Medicare PIN
VAT21596Medicare UPIN