Provider Demographics
NPI:1487369088
Name:GRAVEN, ASHLEY A (CPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:GRAVEN
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3688 NORTH ST # 1
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NY
Mailing Address - Zip Code:13402-9707
Mailing Address - Country:US
Mailing Address - Phone:315-761-2434
Mailing Address - Fax:
Practice Address - Street 1:3688 NORTH ST # 1
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NY
Practice Address - Zip Code:13402-9707
Practice Address - Country:US
Practice Address - Phone:315-761-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N8L4C3C7156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist