Provider Demographics
NPI:1083640429
Name:GRIFASI EYECARE AND OPTICAL, INC.
Entity Type:Organization
Organization Name:GRIFASI EYECARE AND OPTICAL, 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 1:202B SOUTH BRIDGE STR.
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5915
Mailing Address - Country:US
Mailing Address - Phone:410-392-2323
Mailing Address - Fax:410-392-2406
Practice Address - Street 1:202B SOUTH BRIDGE STR.
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5915
Practice Address - Country:US
Practice Address - Phone:410-392-2323
Practice Address - Fax:410-392-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD515LMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER