Individual
DR. JESSICA GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4019 W 12600 SOUTH, SUITE #110, RIVERTON, UT 84096
(801) 302-9482
(801) 302-5532
Mailing address
4019 W 12600 S, #110, RIVERTON, UT 84096
(801) 302-9482
(801) 302-5532
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
5267304-9934
UT
152WC0802X
Corneal and Contact Management Optometrist
Primary
5267304-8904
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52673049901001
BCBS ID #
UT
01
—
84414
PEHP
UT
01
—
868724
DESERET MUTUAL BENEFIT AD
UT
01
—
H870369 0819
GROUP & PENSION ADM.
UT
Enumeration date
10/02/2006
Last updated
09/11/2025
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