Provider Demographics
NPI:1194578906
Name:KULIFAY, DAN J II
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:J
Last Name:KULIFAY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 DORAL DR
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1900
Mailing Address - Country:US
Mailing Address - Phone:330-758-0708
Mailing Address - Fax:330-758-1342
Practice Address - Street 1:1300 DORAL DR
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1900
Practice Address - Country:US
Practice Address - Phone:330-758-0708
Practice Address - Fax:330-758-1342
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.017703-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician