Provider Demographics
NPI:1699098475
Name:DEAN C. GRAY OD, PS
Entity type:Organization
Organization Name:DEAN C. GRAY OD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-468-2020
Mailing Address - Street 1:9671 N NEVADA ST
Mailing Address - Street 2:#210
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1146
Mailing Address - Country:US
Mailing Address - Phone:509-468-2020
Mailing Address - Fax:509-468-3272
Practice Address - Street 1:9671 N NEVADA ST
Practice Address - Street 2:#210
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1146
Practice Address - Country:US
Practice Address - Phone:509-468-2020
Practice Address - Fax:509-468-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6265860001Medicare NSC