Provider Demographics
NPI:1730240151
Name:GRAHAM, LAURI B (OD)
Entity type:Individual
Prefix:DR
First Name:LAURI
Middle Name:B
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1370 S COMMONS DR
Mailing Address - Street 2:STE 102
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7740
Mailing Address - Country:US
Mailing Address - Phone:843-213-1201
Mailing Address - Fax:843-213-1201
Practice Address - Street 1:1206 MOSER DR
Practice Address - Street 2:THE MARKET COMMON
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1575
Practice Address - Country:US
Practice Address - Phone:843-213-1201
Practice Address - Fax:843-213-1207
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2016-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC1396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD13965Medicaid