Gray, Gary G
Gray, Gary G is an sole proprietor health care provider with primary practice located at 2490 N Water St Suite 16, Decatur IL 62526-4251. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Pediatrics. Eye and Vision Services Providers / Corneal and Contact Management is his primary health care specialty. Gray, Gary G can be contacted via phone (217) 875-4646.Contact Information
Primary practice address
2490 N Water St Suite 16
Decatur IL 62526-4251
Phone: (217) 875-4646
Fax: (217) 875-2870
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | Illinois | |
| Eye and Vision Services Providers / Pediatrics | 152WP0200X | Illinois |
Profile Details
| NPI number | 1275603672 |
|---|---|
| LBN Legal business name | Gray, Gary G |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 9th, 2006 |
| Last updated | Nov 20th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275603672 | NPPES |
| Tennessee | Other | 4056086 | BCBCS |
| Tennessee | Other | 5884008 | BCBCS |
| Tennessee | Other | 6259G | BCBCS |
| Tennessee | Other | 0159620001 | BCBCS |
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