Provider Demographics
NPI:1487384939
Name:GRAYTOK, BRIAN (OD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:GRAYTOK
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 1:235 HUMPHREY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4579
Mailing Address - Country:US
Mailing Address - Phone:724-834-8033
Mailing Address - Fax:
Practice Address - Street 1:235 HUMPHREY RD STE 1
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4579
Practice Address - Country:US
Practice Address - Phone:724-834-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003948152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No152W00000XEye and Vision Services ProvidersOptometrist