Provider Demographics
NPI:1942876917
Name:GRADY D. GAFFORD MD PC
Entity Type:Organization
Organization Name:GRADY D. GAFFORD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-724-2131
Mailing Address - Street 1:15 MEADE STREET
Mailing Address - Street 2:SUITE U-1
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901
Mailing Address - Country:US
Mailing Address - Phone:570-265-3668
Mailing Address - Fax:570-265-8936
Practice Address - Street 1:899 CRAFT MASTER ROAD
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-8936
Practice Address - Country:US
Practice Address - Phone:570-265-3668
Practice Address - Fax:570-265-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty