Provider Demographics
NPI:1346362902
Name:GRAFF, BRUCE V (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:V
Last Name:GRAFF
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:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-0308
Mailing Address - Country:US
Mailing Address - Phone:760-326-2149
Mailing Address - Fax:760-326-1224
Practice Address - Street 1:1406 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-3115
Practice Address - Country:US
Practice Address - Phone:760-326-2149
Practice Address - Fax:760-326-1224
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4983152W00000X
AZ80152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ999000380OtherNORIDIAN
CASD0049830Medicaid
CA410002519OtherPALMETTO
CA0643040001Medicare NSC
CA410002519OtherPALMETTO
CASD0049830Medicaid