Provider Demographics
NPI:1124719125
Name:RAY, DAVID ROBERT JR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:RAY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 DURBIN PAVILION DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4119
Mailing Address - Country:US
Mailing Address - Phone:904-417-9670
Mailing Address - Fax:904-287-4325
Practice Address - Street 1:845 DURBIN PAVILION DR
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4119
Practice Address - Country:US
Practice Address - Phone:904-417-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician