Provider Demographics
NPI:1184628091
Name:GRAF, JEFFERY DONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DONALD
Last Name:GRAF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:754 S MAIN ST
Mailing Address - Street 2:STE 6
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5504
Mailing Address - Country:US
Mailing Address - Phone:435-634-0420
Mailing Address - Fax:435-634-5409
Practice Address - Street 1:754 S MAIN ST
Practice Address - Street 2:STE 6
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5504
Practice Address - Country:US
Practice Address - Phone:435-634-0420
Practice Address - Fax:435-634-5409
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114436-9934152W00000X, 152WC0802X, 152WL0500X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
410021393OtherRAILROAD MEDICARE
UT000090504Medicare PIN
UTU09900Medicare UPIN