MEDICARE: DR. MARK DAVID PIFER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3486	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710966817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK DAVID PIFER O.D.

Provider Business Mailing Address
First Line	:	1950 OLD GALLOWS RD STE 520
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-3970
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	571-223-6780

Provider Business Practice Location Address
First Line	:	1355 W MAIN ST
Second Line	:	SUITE A
City	:	BELLEVUE
State	:	OH
Zip	:	44811-9082
Country	:	US
Telephone Number	:	419-483-7685
Fax Number	:	419-483-4694

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	10/21/2020

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