Provider Demographics
NPI:1801989868
Name:GRAHAM, JESSICA
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 W 12600 S
Mailing Address - Street 2:#110
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096
Mailing Address - Country:US
Mailing Address - Phone:801-302-9482
Mailing Address - Fax:801-302-5532
Practice Address - Street 1:4019 W 12600 SOUTH
Practice Address - Street 2:SUITE #110
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096
Practice Address - Country:US
Practice Address - Phone:801-302-9482
Practice Address - Fax:801-302-5532
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5267304-9934152W00000X
UT5267304-8904152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT84414OtherPEHP
UT868724OtherDESERET MUTUAL BENEFIT AD
UT52673049901001OtherBCBS ID #
UTH870369 0819OtherGROUP & PENSION ADM.
UTH870369 0819OtherGROUP & PENSION ADM.