Provider Demographics
NPI:1588793269
Name:GRAHAM, RITA J (ABOC)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:J
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
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Mailing Address - Street 1:4306 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7751
Mailing Address - Country:US
Mailing Address - Phone:505-265-8846
Mailing Address - Fax:505-265-9684
Practice Address - Street 1:4306 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7751
Practice Address - Country:US
Practice Address - Phone:505-265-8846
Practice Address - Fax:505-265-9684
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMABO 5945156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician