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  7. NPI Record 1801989868

DR. JESSICA GRAHAM
Complete NPI Record 1801989868
Optometrist in Riverton, UT

NPI Status: Active since October 02, 2006

Contact Information

4019 W 12600 SOUTH
SUITE #110
RIVERTON, UT
ZIP 84096
Phone: (801) 302-9482
Fax: (801) 302-5532

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Name Prefix Text
  6. Provider First Line Business Mailing Address
  7. Provider Second Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Second Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Business Practice Location Address Fax Number
  22. Provider Enumeration Date
  23. Last Update Date
  24. Provider Gender Code
  25. Healthcare Provider Taxonomy Code 1
  26. Provider License Number 1
  27. Provider License Number State Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Healthcare Provider Taxonomy Code 2
  30. Provider License Number 2
  31. Provider License Number State Code 2
  32. Healthcare Provider Primary Taxonomy Switch 2
  33. Other Provider Identifier 1
  34. Other Provider Identifier Type Code 1
  35. Other Provider Identifier State 1
  36. Other Provider Identifier Issuer 1
  37. Other Provider Identifier 2
  38. Other Provider Identifier Type Code 2
  39. Other Provider Identifier State 2
  40. Other Provider Identifier Issuer 2
  41. Other Provider Identifier 3
  42. Other Provider Identifier Type Code 3
  43. Other Provider Identifier State 3
  44. Other Provider Identifier Issuer 3
  45. Other Provider Identifier 4
  46. Other Provider Identifier Type Code 4
  47. Other Provider Identifier State 4
  48. Other Provider Identifier Issuer 4
  49. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1801989868. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1801989868
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Entity Type Code: 1
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider First Name: JESSICA
The city name in the mailing address of the provider being identified.
Provider Name Prefix Text: DR.
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider First Line Business Mailing Address: 4019 W 12600 S
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Second Line Business Mailing Address: #110
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address City Name: RIVERTON
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Mailing Address State Name: UT
The city name in the location address of the provider being identified.
Provider Business Mailing Address Postal Code: 84096
The State code in the location of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Mailing Address Telephone Number: 8013029482
The country code in the location address of the provider being identified.
Provider Business Mailing Address Fax Number: 8013025532
The telephone number associated with the location address of the provider being identified.
Provider First Line Business Practice Location Address: 4019 W 12600 SOUTH
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE #110
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: RIVERTON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: UT
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 84096
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8013029482
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8013025532
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 10/2/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/9/2007
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 152W00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 5267304-9934
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: UT
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: X
Healthcare Provider Taxonomy Code 2: 152WC0802X
Provider License Number 2: 5267304-8904
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: UT
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: X
Other Provider Identifier 1: 52673049901001
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: UT
Other Provider Identifier Issuer 1: BCBS ID #
Other Provider Identifier 2: 868724
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: UT
Other Provider Identifier Issuer 2: DESERET MUTUAL BENEFIT AD
Other Provider Identifier 3: 84414
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: UT
Other Provider Identifier Issuer 3: PEHP
Other Provider Identifier 4: H870369 0819
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: UT
Other Provider Identifier Issuer 4: GROUP & PENSION ADM.
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No