Russell Lamar Gray, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-100476 Issued in ID

Practice address

129 W Galvani Dr Ste 100
Meridian, ID 83642-8008

Phone

(208) 254-2183

Fax

(208) 281-3697

NPI assigned

Jun 15, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: russell.gray@direct.revolutionehr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• RG Vision Eyecare LLC

  • Optometrist
  • Meridian, ID
  • NPI 1952117434
  Medicare reassignment NPD Authorized official
• Ada Vision Center P.a.

  • Optometrist
  • Boise, ID
  • NPI 1407869589
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772755200000",
    "number": "1023678778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 W GALVANI DR STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428008",
            "telephone_number": "208-254-2183",
            "fax_number": "208-254-2183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 W GALVANI DR STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428008",
            "telephone_number": "208-254-2183",
            "fax_number": "208-281-3697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "RUSSELL",
        "middle_name": "LAMAR",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-15",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "ODP-100476",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tony Lane Grant
• Shellie Dean Graves, NP
• Elizabeth A Gray, NP
• Laura E Gray, LPC, NCC, PHD
• Natalie Kane Gray
• Trent R. Gray, LCPC
• Vanessa Anne Gray, PTA
• Great Western Distribution of Idaho, LLC
• Greater Limits Counseling LLC
• Debra W. Greeff, LMSW

• Optometrist in Meridian, ID
• Providers in Meridian, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.