Provider Demographics
NPI:1780813238
Name:REAL GRAY LLC
Entity type:Organization
Organization Name:REAL GRAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-829-4118
Mailing Address - Street 1:305 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5397
Mailing Address - Country:US
Mailing Address - Phone:301-829-4118
Mailing Address - Fax:
Practice Address - Street 1:305 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5397
Practice Address - Country:US
Practice Address - Phone:301-829-4118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REAL GRAY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty