Provider Demographics
NPI:1467773838
Name:KON GRAVERSEN, VERONICA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:A
Last Name:KON GRAVERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:A
Other - Last Name:KON-JARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1567 HAYLEY LN STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2109
Mailing Address - Country:US
Mailing Address - Phone:239-337-3337
Mailing Address - Fax:239-936-6984
Practice Address - Street 1:1567 HAYLEY LN STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2109
Practice Address - Country:US
Practice Address - Phone:239-337-3337
Practice Address - Fax:239-936-6984
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139314207W00000X, 207WX0107X
FLME139313207WX0108X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease