Provider Demographics
NPI:1154357598
Name:GRIFASI EYECARE AND OPTICAL, III, INC.
Entity type:Organization
Organization Name:GRIFASI EYECARE AND OPTICAL, III, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SALVATORE
Authorized Official - Last Name:GRIFASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-644-1039
Mailing Address - Street 1:17252 N VILLAGE MAIN BLVD
Mailing Address - Street 2:UNIT 6
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:
Practice Address - Street 1:17252 N VILLAGE MAIN BLVD
Practice Address - Street 2:UNIT 6
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6292
Practice Address - Country:US
Practice Address - Phone:302-644-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000035225Medicaid
DE1000035225Medicaid