Provider Demographics
NPI:1952499584
Name:DRS TEIGEN & GRAY
Entity Type:Organization
Organization Name:DRS TEIGEN & GRAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:O
Authorized Official - Last Name:TEIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-468-2020
Mailing Address - Street 1:9671 N NEVADA ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1146
Mailing Address - Country:US
Mailing Address - Phone:509-467-3219
Mailing Address - Fax:
Practice Address - Street 1:9671 N NEVADA ST STE 210
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1146
Practice Address - Country:US
Practice Address - Phone:509-468-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2004398Medicaid
WA2332005Medicaid
WA2004398Medicaid
WAAB09334Medicare ID - Type UnspecifiedGENE O. TEIGEN
WAAB09335Medicare ID - Type UnspecifiedDEAN C. GRAY
WAT86889Medicare UPIN
WA0636480001Medicare ID - Type UnspecifiedDURABLE MEDICAL MEDICARE