Provider Demographics
NPI:1477514560
Name:LAGRAFF, ARNOLD PATRICK (OD)
Entity Type:Individual
Prefix:
First Name:ARNOLD
Middle Name:PATRICK
Last Name:LAGRAFF
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 668
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-0668
Mailing Address - Country:US
Mailing Address - Phone:740-593-3191
Mailing Address - Fax:
Practice Address - Street 1:199 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1315
Practice Address - Country:US
Practice Address - Phone:740-593-3191
Practice Address - Fax:740-594-2525
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0154532Medicaid
OH311684193OtherEIN
OH0154532Medicaid
OH311684193OtherEIN