Provider Demographics
NPI:1194107078
Name:BRAY SHEPHERD EYE CARE PC
Entity type:Organization
Organization Name:BRAY SHEPHERD EYE CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-461-6880
Mailing Address - Street 1:16637 E 23RD ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-1922
Mailing Address - Country:US
Mailing Address - Phone:816-461-6880
Mailing Address - Fax:
Practice Address - Street 1:16637 E 23RD ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-1922
Practice Address - Country:US
Practice Address - Phone:816-461-6880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1730174210OtherNPI
MOU52852Medicare UPIN
MO0007476Medicare PIN