Provider Demographics
NPI:1821106105
Name:GRAY FAMILY VISION CENTER, P.A.
Entity Type:Organization
Organization Name:GRAY FAMILY VISION CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GUISELEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-657-4488
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-1088
Mailing Address - Country:US
Mailing Address - Phone:207-657-4488
Mailing Address - Fax:207-657-4574
Practice Address - Street 1:6 TURNPIKE ACRES ROAD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039
Practice Address - Country:US
Practice Address - Phone:207-657-4488
Practice Address - Fax:207-657-4574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEU59458OtherCOOK MEDICARE UPIN
ME000912OtherGUISELEY ANTHEM #
ME005507769OtherGUISELEY SS#
ME066629534OtherCOOK SS#
ME100225OtherCOOK ANTHEM
ME1194714733OtherCOOK IND NPI
MEMM9058OtherCOOK IND MEDICARE #
ME1558378737OtherIND NPI FOR GUISELEY
ME161630000Medicaid
MET31390OtherGUISELEY IND UPIN #
ME100225OtherCOOK ANTHEM
MEMM9663Medicare PIN