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Organization
1162 MILITARY TRAIL LLC
Active
Organization
1162 MILITARY TRAIL LLC
Active
Other names
Optometric Eyecare Center
Organization subpart
No
Provider details
NPI number
Authorized official
GALEN GRAYSON M.D. (OWNER/MEDICAL DIRECTOR)
(704) 295-0001
Entity
Organization
Contact information
Practice address
1616 S MILITARY TRL, WEST PALM BEACH, FL 33415-5612
(561) 968-1234
(561) 967-9178
Mailing address
8076 W SAHARA AVE, LAS VEGAS, NV 89117-7930
(877) 881-0022
(702) 543-0314
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
152WC0802X
Corneal and Contact Management Optometrist
Primary
—
NULL
152WC0802X
Corneal and Contact Management Optometrist
Primary
—
—
207W00000X
Ophthalmology Physician
—
NULL
207W00000X
Ophthalmology Physician
—
—
Other
Enumeration date
08/21/2012
Last updated
08/21/2012
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