Active NPI
Reid L Grayson, OD
- Optometrist
- Burlington, VT
National Provider Identifier
1073579884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0300000156
- Practice address
- 230 College Street
Suite 1
Burlington, VT 05401 - Phone
- (802) 658-3330
- Fax
- (802) 658-7464
- NPI assigned
- Apr 21, 2006
- Last updated
- Feb 4, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0300000156 | VT | Primary |
Addresses
Primary practice location
230 College Street
Suite 1
Burlington, VT 05401
Mailing address
77 B Pearl Street
Essex Junction, VT 05452
Phone (802) 878-5509
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VT7950 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0300000156 | VT | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454544000000",
"number": "1073579884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 B PEARL STREET",
"city": "ESSEX JUNCTION",
"state": "VT",
"postal_code": "05452",
"telephone_number": "802-878-5509",
"fax_number": "802-879-1350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 COLLEGE STREET",
"address_2": "SUITE 1",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "05401",
"telephone_number": "802-658-3330",
"fax_number": "802-658-7464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAYSON",
"first_name": "REID",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-21",
"last_updated": "2016-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "VT",
"license": "0300000156",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "VT7950",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.