Active NPI
Lewis William Gravely, MD
- Ophthalmology Physician
- Beckley, WV
National Provider Identifier
1629030168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 11494
- Practice address
- 413 Carriage Drive
Beckley, WV 25801-2805 - Phone
- (304) 253-1210
- Fax
- (304) 255-4040
- NPI assigned
- Apr 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 11494 | WV | Primary |
Addresses
Primary practice location
413 Carriage Drive
Beckley, WV 25801-2805
Mailing address
413 Carriage Drive
Beckley, WV 25801-2805
Phone (304) 253-1210
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0095205000 | Medicaid | WV |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11494 | WV | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207785600000",
"number": "1629030168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 CARRIAGE DRIVE",
"city": "BECKLEY",
"state": "WV",
"postal_code": "258012805",
"telephone_number": "304-253-1210",
"fax_number": "304-255-4040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 CARRIAGE DRIVE",
"city": "BECKLEY",
"state": "WV",
"postal_code": "258012805",
"telephone_number": "304-253-1210",
"fax_number": "304-255-4040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAVELY",
"first_name": "LEWIS",
"middle_name": "WILLIAM",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-03",
"last_updated": "2008-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WV",
"license": "11494",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0095205000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beckley, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.