Provider Demographics
NPI:1356321616
Name:GRAHAM, CALVIN F (OD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:F
Last Name:GRAHAM
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 1:1001 LEXINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901
Mailing Address - Country:US
Mailing Address - Phone:479-782-6737
Mailing Address - Fax:479-782-1071
Practice Address - Street 1:1001 LEXINGTON AVE.
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4945
Practice Address - Country:US
Practice Address - Phone:479-782-6737
Practice Address - Fax:479-782-1071
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2072152W00000X
ARAR20723152W00000X
ARAR2072/OP1100009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100760800AMedicaid
AR105711722Medicaid
AR105711722Medicaid
AR4899940001Medicare NSC
OK100760800AMedicaid