Provider Demographics
NPI:1982801239
Name:GAFFKA, JOHN (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GAFFKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:60608 RUSSELL LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9459
Mailing Address - Country:US
Mailing Address - Phone:734-968-6471
Mailing Address - Fax:
Practice Address - Street 1:9190 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-2032
Practice Address - Country:US
Practice Address - Phone:248-698-9782
Practice Address - Fax:248-698-9785
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004424152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist