Provider Demographics
NPI:1700854403
Name:SAFIER, JACK
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:SAFIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 SAMPSON RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1629
Mailing Address - Country:US
Mailing Address - Phone:330-718-2097
Mailing Address - Fax:
Practice Address - Street 1:3711 SAMPSON RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1629
Practice Address - Country:US
Practice Address - Phone:330-718-2097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3201 T633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0352103Medicaid
OHT47523Medicare UPIN
0608870001Medicare NSC
OH0352103Medicaid