Provider Demographics
NPI:1306805510
Name:GRAF, DAVID MCCLEAN (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MCCLEAN
Last Name:GRAF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N 100 E
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2131
Mailing Address - Country:US
Mailing Address - Phone:435-896-8142
Mailing Address - Fax:435-896-9484
Practice Address - Street 1:145 N 100 E
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2131
Practice Address - Country:US
Practice Address - Phone:435-896-8142
Practice Address - Fax:435-896-9484
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5350587-9934152WC0802X, 152WL0500X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005740901Medicare ID - Type Unspecified
UTU97174Medicare UPIN