Provider Demographics
NPI:1053448977
Name:GRAZIAN, ROBERT L (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:GRAZIAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9727 MISSION GORGE RD
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3809
Mailing Address - Country:US
Mailing Address - Phone:619-562-5220
Mailing Address - Fax:
Practice Address - Street 1:9727 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3809
Practice Address - Country:US
Practice Address - Phone:619-562-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7477T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0074771Medicaid
CAU29045Medicare UPIN
CAOP7477Medicare ID - Type UnspecifiedMEDICARE NUMBER