Provider Demographics
NPI:1750715744
Name:RIFAI, MARWAN (OD)
Entity type:Individual
Prefix:DR
First Name:MARWAN
Middle Name:
Last Name:RIFAI
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 1:63 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8527
Mailing Address - Country:US
Mailing Address - Phone:814-226-0909
Mailing Address - Fax:
Practice Address - Street 1:63 PERKINS RD
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8527
Practice Address - Country:US
Practice Address - Phone:814-226-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist