Healthcare Provider Details

I. General information

NPI: 1346362902
Provider Name (Legal Business Name): BRUCE V. GRAFF O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 BAILEY AVE
NEEDLES CA
92363-3115
US

IV. Provider business mailing address

PO BOX 308
NEEDLES CA
92363-0308
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-2149
  • Fax: 760-326-1224
Mailing address:
  • Phone: 760-326-2149
  • Fax: 760-326-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4983
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number80
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: