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Individual
MICHAEL L GRACE
Active
Individual
MICHAEL L GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2710TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80FD
BLUE CROSS BLUE SHIELD
TX
01
—
E15A
BLUE CROSS BLUE SHIELD
TX
01
—
P00693823
MEDICARE RR
TX
Enumeration date
11/15/2005
Last updated
12/03/2020
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