Provider Demographics
NPI:1467587584
Name:GRAZIANO, JEREMY (OD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:GRAZIANO
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 1:310 NW BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3511
Mailing Address - Country:US
Mailing Address - Phone:503-227-4333
Mailing Address - Fax:503-227-4335
Practice Address - Street 1:310 NW BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3511
Practice Address - Country:US
Practice Address - Phone:503-227-4333
Practice Address - Fax:503-227-4335
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2757T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist