MEDICARE: MR. STEVEN I MAZLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	FL1513	FL

General Provider Information

NPI Number	:	1194869339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN I MAZLIN

Provider Business Mailing Address
First Line	:	1851 KNOX MCRAE DR
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-5492
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1851 KNOX MCRAE DR
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-5492
Country	:	US
Telephone Number	:	321-269-3056
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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