Provider Demographics
NPI:1437121449
Name:GRAGG, MISCHELLE DORA (OD)
Entity type:Individual
Prefix:DR
First Name:MISCHELLE
Middle Name:DORA
Last Name:GRAGG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1084 BAYBROOK MALL
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-2744
Mailing Address - Country:US
Mailing Address - Phone:281-480-9799
Mailing Address - Fax:281-480-9798
Practice Address - Street 1:1084 BAYBROOK MALL
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2744
Practice Address - Country:US
Practice Address - Phone:281-480-9799
Practice Address - Fax:281-480-9798
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4086T152W00000X
TX4086TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist