Provider Demographics
NPI:1730409962
Name:ROBERT F GRAY PC
Entity type:Organization
Organization Name:ROBERT F GRAY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-768-4100
Mailing Address - Street 1:785 E 200 S STE 9
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2291
Mailing Address - Country:US
Mailing Address - Phone:801-768-4100
Mailing Address - Fax:801-768-0600
Practice Address - Street 1:785 E 200 S STE 9
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2291
Practice Address - Country:US
Practice Address - Phone:801-768-4100
Practice Address - Fax:801-768-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113649-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529021849020Medicaid
UTU25727Medicare UPIN
UT90036Medicare PIN