Provider Demographics
NPI:1881698793
Name:GRAF, DALE K (OD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:K
Last Name:GRAF
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 1:105 W ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1329
Mailing Address - Country:US
Mailing Address - Phone:509-697-6177
Mailing Address - Fax:509-697-6659
Practice Address - Street 1:105 W ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1329
Practice Address - Country:US
Practice Address - Phone:509-697-6177
Practice Address - Fax:509-697-6659
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261-0001320152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWA0786OtherNORTHWEST BENEFIT NETWORK
WAA002OtherTRICARE SUBMITTER ID
WA038859OtherARBO OE TRACKER CARD
WA17129OtherDEPT OF L&I - SELAH VISIO
WAGR2387OtherREGENCE BLUE SHIELD
WA2011898Medicaid
WA0147685OtherDEPT OF L&I - DR GRAF
WA2051902Medicaid
WA082179 ODOtherCHAMPUS
WA038859OtherARBO OE TRACKER CARD