Provider Demographics
NPI:1881698116
Name:GRIFASI, RICHARD SALVATORE (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:SALVATORE
Last Name:GRIFASI
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 1:17425 OCEAN ONE PLAZA
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6292
Mailing Address - Country:US
Mailing Address - Phone:302-644-1039
Mailing Address - Fax:302-644-4393
Practice Address - Street 1:17425 OCEAN ONE PLAZA
Practice Address - Street 2:UNIT 2
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-644-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE13-0001203152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU06746Medicare UPIN