Provider Demographics
NPI:1366435729
Name:GRAY, DANIEL (OD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GRAY
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 1:7100 SIX FORKS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6156
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-676-2231
Practice Address - Street 1:1975 HIGH HOUSE RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8452
Practice Address - Country:US
Practice Address - Phone:919-461-0771
Practice Address - Fax:919-481-0645
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00010416OtherRAILROAD MEDICARE
NC133PTOtherBLUECROSS
NC89133PTMedicaid
NCP00010416OtherRAILROAD MEDICARE