Provider Demographics
NPI:1487776324
Name:GAROFALO, ANNUNZIATO (OD)
Entity type:Individual
Prefix:DR
First Name:ANNUNZIATO
Middle Name:
Last Name:GAROFALO
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 1:1512 WAYNESBORO DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5333
Mailing Address - Country:US
Mailing Address - Phone:330-425-1615
Mailing Address - Fax:330-425-1615
Practice Address - Street 1:8216 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2337
Practice Address - Country:US
Practice Address - Phone:330-856-4089
Practice Address - Fax:330-425-1615
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032252983336S0011X
OH5308 T2217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000242340OtherANTHEM