Provider Demographics
NPI:1295040202
Name:MICHAEL K GROFIK OD PA
Entity Type:Organization
Organization Name:MICHAEL K GROFIK OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:GROFIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:321-253-9228
Mailing Address - Street 1:278 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8625
Mailing Address - Country:US
Mailing Address - Phone:321-253-9228
Mailing Address - Fax:321-253-9446
Practice Address - Street 1:278 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8625
Practice Address - Country:US
Practice Address - Phone:321-253-9228
Practice Address - Fax:321-253-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1649152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078222000Medicaid
FLDT7408OtherRAILROAD MEDICARE
FL078222000Medicaid
FLDK619AMedicare PIN