Provider Demographics
NPI:1710956131
Name:GRAEBE, RICHARD II
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GRAEBE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CROSSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1444
Mailing Address - Country:US
Mailing Address - Phone:859-879-3665
Mailing Address - Fax:859-879-3662
Practice Address - Street 1:105 CROSSFIELD DR
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1444
Practice Address - Country:US
Practice Address - Phone:859-879-3665
Practice Address - Fax:859-879-3662
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1044-DT152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010445Medicaid
KY77010445Medicaid
KYT54698Medicare UPIN