Healthcare Provider Details

I. General information

NPI: 1417086331
Provider Name (Legal Business Name): BARRY R MOZLIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S EL CAMINO REAL STE A
ENCINITAS CA
92024-4141
US

IV. Provider business mailing address

205 S EL CAMINO REAL STE A
ENCINITAS CA
92024-4141
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-7177
  • Fax: 760-944-9603
Mailing address:
  • Phone: 760-944-7177
  • Fax: 760-944-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6516T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: