Provider Demographics
NPI:1013931153
Name:GRAHAM, STEVEN DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:GRAHAM
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 1:5535 TX-1604 LOOP
Mailing Address - Street 2:SITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253
Mailing Address - Country:US
Mailing Address - Phone:210-688-9272
Mailing Address - Fax:832-660-0881
Practice Address - Street 1:5535 TX-1604 LOOP
Practice Address - Street 2:SITE #104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253
Practice Address - Country:US
Practice Address - Phone:210-688-9272
Practice Address - Fax:620-832-6600
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1366152W00000X
TX4911T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6720150001Medicare NSC
KS052571Medicare PIN
KSU05266Medicare UPIN
KS410035827Medicare PIN