Individual
GARY G GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2490 N WATER ST, SUITE 16, DECATUR, IL 62526-4251
(217) 875-4646
(217) 875-2870
Mailing address
2490 N WATER ST, SUITE 16, DECATUR, IL 62526-4251
(217) 875-4646
(217) 875-2870
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
—
IL
152WP0200X
Pediatric Optometrist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0159620001
DMERC ADMINISTAR
IL
01
—
4056086
BCBCS
TN
01
—
5884008
BCBS
IL
01
—
6259G
UNITED HEALTHCARE
IL
Enumeration date
11/09/2006
Last updated
11/20/2007
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