1821106105 NPI number — GRAY FAMILY VISION CENTER, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821106105 NPI number — GRAY FAMILY VISION CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAY FAMILY VISION CENTER, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821106105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1088
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04039-1088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-657-4488
Provider Business Mailing Address Fax Number:
207-657-4574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 TURNPIKE ACRES ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAY
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-657-4488
Provider Business Practice Location Address Fax Number:
207-657-4574
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUISELEY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
207-657-4488

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT742 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: U59458 . This is a "COOK MEDICARE UPIN" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 000912 . This is a "GUISELEY ANTHEM #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 005507769 . This is a "GUISELEY SS#" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 066629534 . This is a "COOK SS#" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 100225 . This is a "COOK ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1194714733 . This is a "COOK IND NPI" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: MM9058 . This is a "COOK IND MEDICARE #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1558378737 . This is a "IND NPI FOR GUISELEY" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 161630000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: T31390 . This is a "GUISELEY IND UPIN #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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