Provider Demographics
NPI:1073549416
Name:GRIFASI EYECARE & OPTICAL II, INC.
Entity Type:Organization
Organization Name:GRIFASI EYECARE & OPTICAL II, INC.
Other - Org Name:HOLLOWAY EYE CARE & OPTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:HOLLOWAY
Authorized Official - Last Name:GRIFASI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-939-7717
Mailing Address - Street 1:2015-C PULASKI HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2144
Mailing Address - Country:US
Mailing Address - Phone:410-939-7717
Mailing Address - Fax:410-939-7739
Practice Address - Street 1:2015-C PULASKI HIGHWAY
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2144
Practice Address - Country:US
Practice Address - Phone:410-939-7717
Practice Address - Fax:410-939-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD997LMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER