Provider Demographics
NPI:1992806566
Name:GRAU, JAMES EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:GRAU
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:699 MCBROOM ST NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2511
Mailing Address - Country:US
Mailing Address - Phone:276-628-1143
Mailing Address - Fax:276-628-9522
Practice Address - Street 1:699 MCBROOM ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2511
Practice Address - Country:US
Practice Address - Phone:276-628-1143
Practice Address - Fax:276-628-9522
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0618000167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009205136Medicaid
VAT21596Medicare UPIN
VAVAA103469Medicare PIN
VA009205136Medicaid