Provider Demographics
NPI:1851329544
Name:GRAY, ROBIN LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:LYNN
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 1:108 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2257
Mailing Address - Country:US
Mailing Address - Phone:609-927-6086
Mailing Address - Fax:
Practice Address - Street 1:921 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-4129
Practice Address - Country:US
Practice Address - Phone:609-641-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA04027 TO00250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ159248ACYMedicare ID - Type Unspecified
NJT84901Medicare UPIN