Provider Demographics
NPI:1336816370
Name:GRAFE, BRENDAN (MSC, CNIM)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:GRAFE
Suffix:
Gender:M
Credentials:MSC, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 N OLIVE DR APT 306
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2773
Mailing Address - Country:US
Mailing Address - Phone:978-417-1647
Mailing Address - Fax:
Practice Address - Street 1:20331 IRVINE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0223
Practice Address - Country:US
Practice Address - Phone:877-987-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty