Provider Demographics
NPI:1033129531
Name:CARIFA, SAM G (OD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:G
Last Name:CARIFA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5797 BEECHCROFT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2758
Mailing Address - Country:US
Mailing Address - Phone:614-891-0660
Mailing Address - Fax:614-882-4170
Practice Address - Street 1:5797 BEECHCROFT RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2758
Practice Address - Country:US
Practice Address - Phone:614-891-0660
Practice Address - Fax:614-882-4170
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3928152W00000X
OH960T47152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0224144Medicaid
OH0224144Medicaid
U10165Medicare UPIN