Provider Demographics
NPI:1851310528
Name:BALCER, GRAHAM ARON (OD)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:ARON
Last Name:BALCER
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 3120
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-3120
Mailing Address - Country:US
Mailing Address - Phone:541-536-2911
Mailing Address - Fax:541-536-2913
Practice Address - Street 1:51530 HUNTINGTON RD
Practice Address - Street 2:SUITE #1
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-7507
Practice Address - Country:US
Practice Address - Phone:541-536-2911
Practice Address - Fax:541-536-2913
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3178ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274547Medicaid
ORV10007Medicare UPIN
ORR135055Medicare PIN