# JERI D. GRAHAM O.D.,P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619314978
- **Authorized official:** DR. JERI D GRAHAM O.D.,P.A. (PRESIDENT)
- **Authorized official phone:** (407) 263-3937

## Contact information

- **Practice address:** 1239 SR 436, SUITE 101, CASSELBERRY, FL 32707-2707
- **Practice address phone:** (407) 263-3937
- **Practice address fax:** (407) 671-9656
- **Mailing address:** 1239 SR 436, SUITE 101, CASSELBERRY, FL 32707-2707
- **Mailing address phone:** (407) 263-3937
- **Mailing address fax:** (407) 671-9656

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC2446 | FL | Yes |

## Other

- **Enumeration date:** 05/28/2013
- **Last updated:** 09/02/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 078790600 | — | FL |
| 01 | — | 1851328496 | INDIIDUAL NPI | FL |