Provider Demographics
NPI:1790757904
Name:GRAY, ROBERT F (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:GRAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9623 W 8170 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3141
Mailing Address - Country:US
Mailing Address - Phone:801-768-0566
Mailing Address - Fax:
Practice Address - Street 1:785 E 200 S
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2291
Practice Address - Country:US
Practice Address - Phone:801-768-4100
Practice Address - Fax:801-768-0600
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113649-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0550680001OtherDMERC SUPPLIER NUMBER
UTMG1017309OtherDEA NUMBER
UT90036Medicare PIN
UT0550680001OtherDMERC SUPPLIER NUMBER