Provider Demographics
NPI:1790973964
Name:GRAY, LORI (OD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
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 1:1806 SWAMP PIKE
Mailing Address - Street 2:STE 400
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9307
Mailing Address - Country:US
Mailing Address - Phone:610-323-4445
Mailing Address - Fax:610-323-4377
Practice Address - Street 1:1806 SWAMP PIKE
Practice Address - Street 2:STE 400
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-9307
Practice Address - Country:US
Practice Address - Phone:610-323-4445
Practice Address - Fax:610-323-4377
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist