Provider Demographics
NPI:1558374173
Name:JEFFERY D GRAF OD PC
Entity Type:Organization
Organization Name:JEFFERY D GRAF OD PC
Other - Org Name:GRAF MEDICAL EYE CARE AND VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-634-0420
Mailing Address - Street 1:754 S MAIN ST
Mailing Address - Street 2:STE 6
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-634-0420
Mailing Address - Fax:435-634-5409
Practice Address - Street 1:754 S MAIN ST
Practice Address - Street 2:STE 6
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-634-0420
Practice Address - Fax:435-634-5409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114436-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DN1610OtherRAILROAD MEDICARE
UT000059324Medicare PIN
DN1610OtherRAILROAD MEDICARE