Provider Demographics
NPI:1215071733
Name:GRAEBE, DOUGLAS KENT (O D)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:KENT
Last Name:GRAEBE
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WILLIAMSBURG CIR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5525
Mailing Address - Country:US
Mailing Address - Phone:304-242-1145
Mailing Address - Fax:
Practice Address - Street 1:50 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6241
Practice Address - Country:US
Practice Address - Phone:740-695-3822
Practice Address - Fax:740-695-3822
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV682-D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist