Provider Demographics
NPI:1710966817
Name:PIFER, MARK DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:PIFER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1355 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9082
Practice Address - Country:US
Practice Address - Phone:419-483-7685
Practice Address - Fax:419-483-4694
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0664688Medicaid
OHT47417Medicare UPIN
OH0664688Medicaid
OH0409930001Medicare NSC
OH410044752Medicare PIN