Provider Demographics
NPI:1497959720
Name:DAVID M GRAF OD PC
Entity Type:Organization
Organization Name:DAVID M GRAF OD PC
Other - Org Name:VALLEY VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RHINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-201-0589
Mailing Address - Street 1:145 N 100 E
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2131
Mailing Address - Country:US
Mailing Address - Phone:435-896-8142
Mailing Address - Fax:435-896-9484
Practice Address - Street 1:145 N 100 E
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701
Practice Address - Country:US
Practice Address - Phone:435-896-8142
Practice Address - Fax:435-896-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1098119934152W00000X
UT53505879934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057409Medicare PIN
0532160001Medicare NSC