Organization
JERI D. GRAHAM O.D.,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERI D GRAHAM O.D.,P.A. (PRESIDENT)
(407) 263-3937
Entity
Organization
Contact information
Practice address
1239 SR 436, SUITE 101, CASSELBERRY, FL 32707-2707
(407) 263-3937
(407) 671-9656
Mailing address
1239 SR 436, SUITE 101, CASSELBERRY, FL 32707-2707
(407) 263-3937
(407) 671-9656
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC2446
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078790600
—
FL
01
—
1851328496
INDIIDUAL NPI
FL
Enumeration date
05/28/2013
Last updated
09/02/2014
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