Provider Demographics
NPI:1295760981
Name:COLEY, GREGORY WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WILLIAM
Last Name:COLEY
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 1:129 E CLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2112
Mailing Address - Country:US
Mailing Address - Phone:615-893-8847
Mailing Address - Fax:615-896-3677
Practice Address - Street 1:129 E CLARK BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2112
Practice Address - Country:US
Practice Address - Phone:615-893-8847
Practice Address - Fax:615-896-3677
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3598283Medicaid
TN4052027OtherBC/BS GROUP
TN9366060OtherPHCS
TN2240263OtherUNITED HEALTH CARE
TN3052066OtherTN CARE SELECT
TN0448280001OtherDMERC
TN12642OtherHEALTHNET BLOCK
TN3052066OtherBC/BS
MI7102000TN37130OtherBC/BS OF MICHIGAN
TN1668918OtherCIGNA
TN3597340Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE
TN4052027OtherBC/BS GROUP
TN3598283Medicare ID - Type UnspecifiedMEDICARE - GROUP