Provider Demographics
NPI:1093196974
Name:DR. BEN V. GRAHAM, O.D., PH.D., P.A.
Entity Type:Organization
Organization Name:DR. BEN V. GRAHAM, O.D., PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-345-3360
Mailing Address - Street 1:2143 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4023
Mailing Address - Country:US
Mailing Address - Phone:727-345-3360
Mailing Address - Fax:727-345-8945
Practice Address - Street 1:2143 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4023
Practice Address - Country:US
Practice Address - Phone:727-345-3360
Practice Address - Fax:727-345-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty