Provider Demographics
NPI:1043214836
Name:GRAVES, NANCY JANE (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JANE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3102 GOLANSKY BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4244
Mailing Address - Country:US
Mailing Address - Phone:703-590-2888
Mailing Address - Fax:703-590-1121
Practice Address - Street 1:3102 GOLANSKY BLVD
Practice Address - Street 2:STE 101
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4244
Practice Address - Country:US
Practice Address - Phone:703-590-2888
Practice Address - Fax:703-590-1121
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618000496152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0937760001OtherMEDICARE SUPPLIER NUMBER
VA1477731172OtherPRACTICE NPI
VA1477731172OtherPRACTICE NPI
VAVV8066AMedicare PIN