Individual
DR. GLENN NICOLAS GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1245 BROAD ST, SAN LUIS OBISPO, CA 93401
(805) 542-0700
(805) 784-9309
Mailing address
1245 BROAD ST, SAN LUIS OBISPO, CA 93401
(805) 542-0700
(805) 784-9309
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7203T
CA
Other
Enumeration date
10/03/2006
Last updated
01/22/2014
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