Healthcare Provider Details

I. General information

NPI: 1366415713
Provider Name (Legal Business Name): MARK EDWARD SCHIFFMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BRADFORD ST. POB 212,
PROVINCETOWN MA
02657-0212
US

IV. Provider business mailing address

120 BRADFORD ST. PO BOX 212,
PROVINCETOWN MA
02657-0212
US

V. Phone/Fax

Practice location:
  • Phone: 508-487-2227
  • Fax:
Mailing address:
  • Phone: 508-487-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3180
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: