Provider Demographics
NPI:1891000410
Name:GRAY, LEAH MONETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:MONETTE
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 1:3624 AUSTIN PEAY HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-3776
Mailing Address - Country:US
Mailing Address - Phone:901-729-7780
Mailing Address - Fax:901-729-7785
Practice Address - Street 1:3624 AUSTIN PEAY HWY STE 6
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3771
Practice Address - Country:US
Practice Address - Phone:901-494-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2884152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist