Provider Demographics
NPI:1134359979
Name:GRAZIANI, STEPHANIE CLAIRE (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CLAIRE
Last Name:GRAZIANI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:CLAIRE
Other - Last Name:JASO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9467 IRON MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7722
Mailing Address - Country:US
Mailing Address - Phone:941-780-0328
Mailing Address - Fax:
Practice Address - Street 1:18148 W 92ND LN UNIT 400
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-8164
Practice Address - Country:US
Practice Address - Phone:720-722-5535
Practice Address - Fax:720-722-5538
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03316992Medicaid
NY03316992Medicaid