Provider Demographics
NPI:1740374305
Name:MARK D PIFER & CHRIS A CALAWAY
Entity type:Organization
Organization Name:MARK D PIFER & CHRIS A CALAWAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:CALAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-745-1969
Mailing Address - Street 1:31 CONSERVATORY DR
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203
Mailing Address - Country:US
Mailing Address - Phone:330-745-1969
Mailing Address - Fax:330-753-9162
Practice Address - Street 1:31 CONSERVATORY DR
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203
Practice Address - Country:US
Practice Address - Phone:330-745-1969
Practice Address - Fax:330-753-9162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3522152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0812188Medicaid
OH9933041Medicare ID - Type Unspecified
OH0812188Medicaid