Provider Demographics
NPI:1063425569
Name:GRAY, DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
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 1:3500 N MIDKIFF RD
Mailing Address - Street 2:STE100
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-4834
Mailing Address - Country:US
Mailing Address - Phone:432-699-1300
Mailing Address - Fax:432-694-1981
Practice Address - Street 1:3500 N MIDKIFF RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4834
Practice Address - Country:US
Practice Address - Phone:432-699-1300
Practice Address - Fax:432-694-1981
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6216TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161462002Medicaid
TX80898QOtherBCBS
TXP00033777OtherMEDICARE RAILROAD
TX80898QOtherBCBS
TX6267490001Medicare NSC
TX8F22357Medicare PIN