Provider Demographics
NPI:1922207745
Name:GREY EYE CARE PC
Entity Type:Organization
Organization Name:GREY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:970-272-8812
Mailing Address - Street 1:1120 WELLINGTON AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6129
Mailing Address - Country:US
Mailing Address - Phone:970-242-8812
Mailing Address - Fax:970-242-8898
Practice Address - Street 1:1120 WELLINGTON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6129
Practice Address - Country:US
Practice Address - Phone:970-242-8812
Practice Address - Fax:970-242-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35516207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22707255Medicaid
CO35516OtherMEDICAL LICENSE
COF71889Medicare UPIN
CO22707255Medicaid
COC809301Medicare PIN