MEDICARE: DR. JEFFERY DONALD GRAF OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	114436-9934	UT
2	152WC0802X	Corneal and Contact Management Optometrist	114436-9934	UT
3	152WL0500X	Low Vision Rehabilitation Optometrist	114436-9934	UT
4	152WP0200X	Pediatric Optometrist	114436-9934	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410021393	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1184628091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY DONALD GRAF OD

Provider Business Mailing Address
First Line	:	754 S MAIN ST
Second Line	:	STE 6
City	:	SAINT GEORGE
State	:	UT
Zip	:	84770-5504
Country	:	US
Telephone Number	:	435-634-0420
Fax Number	:	435-634-5409

Provider Business Practice Location Address
First Line	:	754 S MAIN ST
Second Line	:	STE 6
City	:	SAINT GEORGE
State	:	UT
Zip	:	84770-5504
Country	:	US
Telephone Number	:	435-634-0420
Fax Number	:	435-634-5409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	06/05/2008

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