Provider Demographics
NPI:1558497669
Name:GRAHAM, BEN VICTOR (OD)
Entity type:Individual
Prefix:DR
First Name:BEN
Middle Name:VICTOR
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11850 SHERRI LN
Mailing Address - Street 2:11850 SHERRI LANE
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4832
Mailing Address - Country:US
Mailing Address - Phone:305-279-6404
Mailing Address - Fax:305-279-6978
Practice Address - Street 1:11850 SHERRI LN
Practice Address - Street 2:11850 SHERRI LANE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4832
Practice Address - Country:US
Practice Address - Phone:305-279-6404
Practice Address - Fax:305-279-6978
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist