Provider Demographics
NPI:1447657200
Name:GRAVES, JAMES (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GRAVES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3455 REWAK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5024
Mailing Address - Country:US
Mailing Address - Phone:907-474-8695
Mailing Address - Fax:907-474-8727
Practice Address - Street 1:3455 REWAK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5024
Practice Address - Country:US
Practice Address - Phone:907-474-8695
Practice Address - Fax:907-474-8727
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK97152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist