Graham's Optique Boutique Inc

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

GRAHAM'S OPTIQUE BOUTIQUE INC

Practice address

20100 Outer Dr
Dearborn, MI 48124-2647

Phone

(313) 562-0001

Fax

(313) 562-4840

NPI assigned

Feb 10, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Joseph L Derose, OPTICAN

Title

Optican

Phone

(313) 562-0001

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412812800000",
    "number": "1821061714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20100 OUTER DRIVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242920",
            "telephone_number": "313-562-0001",
            "fax_number": "313-562-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20100 OUTER DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242647",
            "telephone_number": "313-562-0001",
            "fax_number": "313-562-4840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM'S OPTIQUE BOUTIQUE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-10",
        "last_updated": "2014-10-09",
        "status": "A",
        "authorized_official_last_name": "DEROSE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OPTICAN",
        "authorized_official_telephone_number": "313-562-0001",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPTICAN"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
            "identifier": "54OH20415",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tawanda Mechelle Grady
• Jennifer L Graf, CRNA
• Amanda Ruth Graham, LMSW
• Bettina J Graham, MSW
• Shaveonte Denise Graham, MD
• Jure Grahovac
• Marija Jamie Grahovac, M.D.
• Jill Granata, WHNP-BC
• Stanley Chase Grandon, M.D.
• Bryan Granger, LPC

• Optician in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Optician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.