Provider Demographics
NPI:1609831080
Name:RAFF, MICHAEL LEE (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:RAFF
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 1:38 FARM FIELD LN
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2865
Mailing Address - Country:US
Mailing Address - Phone:585-248-2141
Mailing Address - Fax:
Practice Address - Street 1:22 N MAIN ST
Practice Address - Street 2:LOWER SUITE
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1614
Practice Address - Country:US
Practice Address - Phone:585-637-2121
Practice Address - Fax:585-637-7722
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 0004091-1152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1149880001Medicare NSC
NYT25904Medicare UPIN
NY14106BMedicare PIN