Provider Demographics
NPI:1639102114
Name:GAROFALO, RAFE (OD)
Entity Type:Individual
Prefix:DR
First Name:RAFE
Middle Name:
Last Name:GAROFALO
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 1:110 EVERGREEN SQUARE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063
Mailing Address - Country:US
Mailing Address - Phone:320-629-7262
Mailing Address - Fax:320-627-7789
Practice Address - Street 1:110 EVERGREEN SQUARE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063
Practice Address - Country:US
Practice Address - Phone:320-629-7262
Practice Address - Fax:320-627-7789
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN790218200Medicaid
MG1019416OtherDEA
U66284Medicare UPIN
MN790218200Medicaid