Provider Demographics
NPI:1912010182
Name:GREGORY, HAROLD CLIF (OD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:CLIF
Last Name:GREGORY
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 1:500 W NEW CIRCLE RD
Mailing Address - Street 2:EYEMAX
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1833
Mailing Address - Country:US
Mailing Address - Phone:859-225-4657
Mailing Address - Fax:
Practice Address - Street 1:500 W NEW CIRCLE RD
Practice Address - Street 2:EYEMAX
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1833
Practice Address - Country:US
Practice Address - Phone:859-225-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1260DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU46267Medicare UPIN