Provider Demographics
NPI:1982773156
Name:GRAY, ERICK ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:ALAN
Last Name:GRAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6800 LAUREL BOWIE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1709
Mailing Address - Country:US
Mailing Address - Phone:301-464-4442
Mailing Address - Fax:301-464-2554
Practice Address - Street 1:6800 LAUREL BOWIE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1709
Practice Address - Country:US
Practice Address - Phone:301-464-4442
Practice Address - Fax:301-464-2554
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212373Medicare UPIN