Organization
DR. MARK L. JAFFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK LAWRENCE JAFFE O.D. (OWNER)
(623) 979-8876
Entity
Organization
Contact information
Practice address
6666 W PEORIA AVE, SUITE 109, GLENDALE, AZ 85302-7014
(623) 979-8876
(623) 979-2811
Mailing address
6666 W PEORIA AVE, SUITE 109, GLENDALE, AZ 85302-7014
(623) 979-8876
(623) 979-2811
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
114
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114
STATE OPTOMETRIC LICENSE
AZ
Enumeration date
01/17/2007
Last updated
08/22/2020
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