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Individual
DR. ROBERT JACKSON GRAHAM
Active
Individual
DR. ROBERT JACKSON GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0008729T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6567
MEDICAL EYE SERVICES
CA
01
—
770541071
VISION SERVICE PLAN
CA
05
—
S000872901
—
CA
Enumeration date
12/01/2005
Last updated
08/21/2012
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