Provider Demographics
NPI:1740583442
Name:SMITH-GRAY, ANDREA KAY (OD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAY
Last Name:SMITH-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 1:419 W REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1734
Mailing Address - Country:US
Mailing Address - Phone:667-214-2005
Mailing Address - Fax:410-328-8327
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:667-214-2005
Practice Address - Fax:410-328-8327
Is Sole Proprietor?:No
Enumeration Date:2010-12-19
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist