Provider Demographics
NPI:1366415713
Name:SCHIFFMAN, MARK EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:SCHIFFMAN
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 1:120 BRADFORD ST.
Mailing Address - Street 2:PO BOX 212,
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-0212
Mailing Address - Country:US
Mailing Address - Phone:508-487-2227
Mailing Address - Fax:
Practice Address - Street 1:120 BRADFORD ST.
Practice Address - Street 2:POB 212,
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-0212
Practice Address - Country:US
Practice Address - Phone:508-487-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3180152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9770852Medicaid
MA0353795Medicaid
MA9770852Medicaid