Healthcare Provider Details

I. General information

NPI: 1114991460
Provider Name (Legal Business Name): CLIFFORD ALAN ROFFIS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 S LABURNUM AVE
RICHMOND VA
23231-2713
US

IV. Provider business mailing address

4811 S LABURNUM AVE
RICHMOND VA
23231-2713
US

V. Phone/Fax

Practice location:
  • Phone: 804-226-1144
  • Fax: 804-236-9026
Mailing address:
  • Phone: 804-226-1144
  • Fax: 804-236-9026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000234
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: