Provider Demographics
NPI:1689674129
Name:GRAYSON, DOUGLAS K (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:K
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485A US HIGHWAY 1 S
Mailing Address - Street 2:BUILDING A
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-3012
Mailing Address - Country:US
Mailing Address - Phone:732-750-0400
Mailing Address - Fax:732-750-1507
Practice Address - Street 1:485A US HIGHWAY 1 S
Practice Address - Street 2:BUILDING A
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-3012
Practice Address - Country:US
Practice Address - Phone:732-750-0400
Practice Address - Fax:732-750-1507
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06225100207W00000X, 207WX0009X
NY1827361207W00000X
NY182736-1207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ566609QHYOtherMEDICARE
NY01486635Medicaid
NJ6675808Medicaid
NJ566609QHYMedicare PIN
NY057051Medicare PIN
NY566609QHYMedicare PIN
NJ566609QHYOtherMEDICARE
NJ566609MP7Medicare ID - Type Unspecified
F63869Medicare UPIN
NYDG080H8510Medicare ID - Type Unspecified