Doctor Name: | SUSAN GRAYSON |
NPI Number: | 1932271707 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 111 W Washington St Demopolis, AL - 367322043 |
Business Phone Number: | 3342894749 |
Business Fax Number: | 3342872197 |
Mailing Address: | 111 W Washington St, DEMOPOLIS |
State: | AL |
Postal Code: | 367322043 |
Phone Number: | 3342894749 |
Fax Number: | 3342872197 |
NPI Enumeration Date: | 11/15/2006 |
NPI Last Update Date: | 06/10/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |