Individual
DR. MARK LAWRENCE JAFFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
6666 W PEORIA AVE, STE 109, GLENDALE, AZ 85302-7032
(623) 979-8876
(623) 979-2811
Mailing address
6404 W WETHERSFIELD RD, GLENDALE, AZ 85304-1630
(623) 878-8538
(623) 878-8538
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
114
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00360908
RAIL ROAD MEDICARE
AZ
Enumeration date
06/01/2005
Last updated
01/02/2008
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