Paul William Graves, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

354 Issued in NM

Practice address

1300 S 2ND St
Gallup, NM 87301-5813

Phone

(505) 722-3388

Fax

(505) 722-3530

NPI assigned

Apr 2, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801917596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 S 2ND ST",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015813",
            "telephone_number": "505-722-3388",
            "fax_number": "505-722-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S 2ND ST",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015813",
            "telephone_number": "505-722-3388",
            "fax_number": "505-722-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVES",
        "first_name": "PAUL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NM",
            "license": "354",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P0698",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John M Gossard, M.D.
• Megan Elizabeth Gossen
• Evan Gourley, RN
• Steven Joseph Graham
• Temika Dawn Graham
• Charleston Gray
• Leah Gray
• Lynn Gray, RN
• Gayle Graybill, RN
• Lenise Mae Grayson, BSN, RN

• Optometrist in Gallup, NM
• Providers in Gallup, NM by specialty
• Optometrist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.