Provider Demographics
NPI:1942297098
Name:GRIFFEN, CHARLES N JR (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:N
Last Name:GRIFFEN
Suffix:JR
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 1:270 W LANCASTER AVE
Mailing Address - Street 2:SUITE F1
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1858
Mailing Address - Country:US
Mailing Address - Phone:610-647-6550
Mailing Address - Fax:610-647-6549
Practice Address - Street 1:270 LANCASTER AVE
Practice Address - Street 2:SUITE F1
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1858
Practice Address - Country:US
Practice Address - Phone:610-647-6550
Practice Address - Fax:610-647-6549
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000170152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50877OtherAETNA
T30591Medicare UPIN
PA0604390001Medicare NSC
PA467060Medicare PIN