Graham, Jessica
Graham, Jessica is an individual health care provider with primary practice located at 4019 W 12600 South Suite #110, Riverton UT 84096. She recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management. Eye and Vision Services Providers / Optometrist is her primary health care specialty. Graham, Jessica can be contacted via phone (801) 302-9482.Contact Information
Primary practice address
4019 W 12600 South Suite #110
Riverton UT 84096
Phone: (801) 302-9482
Fax: (801) 302-5532
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 5267304-9934 | Utah |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 5267304-8904 | Utah |
Profile Details
| NPI number | 1801989868 |
|---|---|
| LBN Legal business name | Graham, Jessica |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 2nd, 2006 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1801989868 | NPPES |
| Utah | Other | 84414 | PEHP |
| Utah | Other | 868724 | PEHP |
| Utah | Other | 52673049901001 | PEHP |
| Utah | Other | H870369 0819 | PEHP |
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