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NPI Code Detail

MEDICARE: JAMES GRAVES O.D.

MEDICARE:   JAMES  GRAVES  O.D.
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
1152W00000XOptometrist97AK

General Provider Information

NPI Number : 1447657200
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES GRAVES O.D.
Provider Business Mailing Address
First Line : 3455 REWAK DR
Second Line : SUITE 102
City : FAIRBANKS
State : AK
Zip : 99709-5024
Country : US
Telephone Number : 907-474-8695
Fax Number : 907-474-8727
Provider Business Practice Location Address
First Line : 3455 REWAK DR
Second Line : SUITE 102
City : FAIRBANKS
State : AK
Zip : 99709-5024
Country : US
Telephone Number : 907-474-8695
Fax Number : 907-474-8727
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2014
Last Update Date : 11/21/2014

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