Provider Demographics
NPI:1821028127
Name:GRAY, JOHN R (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:GRAY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:113 BATTLEFIELD MALL
Mailing Address - Street 2:SPRINGFIELD EYECARE LLC
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804
Mailing Address - Country:US
Mailing Address - Phone:417-887-6883
Mailing Address - Fax:417-887-6884
Practice Address - Street 1:113 BATTLEFIELD MALL
Practice Address - Street 2:SPRINGFIELD EYECARE, LLC
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-887-6883
Practice Address - Fax:417-887-6884
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOTO2165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist