Organization
DR. NANCY J. GRAVES, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NANCY JANE GRAVES O.D. (OPTOMETRIST)
(703) 590-2888
Entity
Organization
Contact information
Practice address
3102 GOLANSKY BLVD, SUITE 101, WOODBRIDGE, VA 22192-4244
(703) 590-2888
(703) 590-1121
Mailing address
3102 GOLANSKY BLVD, SUITE 101, WOODBRIDGE, VA 22192-4244
(703) 590-2888
(703) 590-1121
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000496
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0937760001
MEDICARE SUPPLIER NUMBER
VA
01
—
1043214834
NPI
VT
01
—
VV8066A
MEDICARE PTAN
VA
Enumeration date
02/05/2008
Last updated
11/29/2012
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