Provider Demographics
NPI:1982757696
Name:GARREFFA, ANTHONY J
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:GARREFFA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:J
Other - Last Name:GARREFFA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:7417 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1502
Mailing Address - Country:US
Mailing Address - Phone:708-366-2020
Mailing Address - Fax:708-366-3265
Practice Address - Street 1:7417 MADISON ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1502
Practice Address - Country:US
Practice Address - Phone:708-366-2020
Practice Address - Fax:708-366-3265
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007331152W00000X
CO2318152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046007331OtherILLINOIS MEDICAID NUMBER
ILT37504Medicare UPIN
IL653891Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER