MEDICARE: LYNDON GRAVES, P.C.

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	998	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598714008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNDON GRAVES, P.C.

Provider Business Mailing Address
First Line	:	9239 W CENTER RD
Second Line	:	SUITE 103
City	:	OMAHA
State	:	NE
Zip	:	68124-1933
Country	:	US
Telephone Number	:	402-898-3232
Fax Number	:	402-898-3234

Provider Business Practice Location Address
First Line	:	9239 W CENTER RD
Second Line	:	SUITE 103
City	:	OMAHA
State	:	NE
Zip	:	68124-1933
Country	:	US
Telephone Number	:	402-898-3232
Fax Number	:	402-898-3234

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	LYNDON JAY GRAVES
Credential	:	O.D.
Telephone Number	:	402-898-3232

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	03/23/2011

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Directions to “LYNDON GRAVES, P.C. ” Practice Location

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