Provider Demographics
NPI:1700172954
Name:GRAVES, MERIN AMANDA (OD)
Entity type:Individual
Prefix:
First Name:MERIN
Middle Name:AMANDA
Last Name:GRAVES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-5608
Mailing Address - Country:US
Mailing Address - Phone:205-425-5182
Mailing Address - Fax:205-426-5013
Practice Address - Street 1:1755 AL-77
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AL
Practice Address - Zip Code:35907-0103
Practice Address - Country:US
Practice Address - Phone:256-442-6200
Practice Address - Fax:256-442-6292
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4669152W00000X
ALS-C72-TA-911152W00000X
TX7827T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL137449Medicaid
AL102I411707Medicare UPIN