Healthcare Provider Details

I. General information

NPI: 1083922934
Provider Name (Legal Business Name): BENJAMIN I GRAHAM OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

V. Phone/Fax

Practice location:
  • Phone: 916-366-5463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT15181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: