Individual
DR. JEFFREY PAUL GRAVIET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
170 S SENECA SPRINGS WAY, STE 100, STAR, ID 83669-5938
(208) 898-4112
Mailing address
170 S SENECA SPRINGS WAY STE 100, STAR, ID 83669-5938
(208) 898-4112
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-1021
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807258500
—
ID
Enumeration date
05/06/2006
Last updated
09/17/2012
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