Provider Demographics
NPI:1962637603
Name:GRAHL, LAUREN HAYNIE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:HAYNIE
Last Name:GRAHL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2905
Mailing Address - Country:US
Mailing Address - Phone:478-987-2020
Mailing Address - Fax:478-988-4628
Practice Address - Street 1:1105 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2905
Practice Address - Country:US
Practice Address - Phone:478-987-2020
Practice Address - Fax:478-988-4628
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist