MEDICARE: DR. DALE K. GRAF 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
1	152W00000X	Optometrist	261-0001320	WA
2	152WC0802X	Corneal and Contact Management Optometrist	261-0001320	WA
3	152WL0500X	Low Vision Rehabilitation Optometrist	261-0001320	WA
4	152WP0200X	Pediatric Optometrist	261-0001320	WA
5	152WS0006X	Sports Vision Optometrist	261-0001320	WA
6	152WV0400X	Vision Therapy Optometrist	261-0001320	WA
7	152WX0102X	Occupational Vision Optometrist	261-0001320	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WA0786	OTHER	WA	NORTHWEST BENEFIT NETWORK
2	A002	OTHER	WA	TRICARE SUBMITTER ID
3	038859	OTHER	WA	ARBO OE TRACKER CARD
4	17129	OTHER	WA	DEPT OF L&I - SELAH VISIO
5	GR2387	OTHER	WA	REGENCE BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0147685	OTHER	WA	DEPT OF L&I - DR GRAF
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	082179 OD	OTHER	WA	CHAMPUS

General Provider Information

NPI Number	:	1881698793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE K. GRAF O.D.

Provider Business Mailing Address
First Line	:	105 W ORCHARD AVE
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942-1329
Country	:	US
Telephone Number	:	509-697-6177
Fax Number	:	509-697-6659

Provider Business Practice Location Address
First Line	:	105 W ORCHARD AVE
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942-1329
Country	:	US
Telephone Number	:	509-697-6177
Fax Number	:	509-697-6659

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	02/13/2008

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