Provider Demographics
NPI:1891881165
Name:BRAY, COREY DEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:DEAN
Last Name:BRAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2862 E. CHEROKEE TRAIL DR.
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802
Mailing Address - Country:US
Mailing Address - Phone:812-298-0170
Mailing Address - Fax:
Practice Address - Street 1:650 KIMMELL RD.
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591
Practice Address - Country:US
Practice Address - Phone:812-886-3914
Practice Address - Fax:812-886-3916
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist