Healthcare Provider Details

I. General information

NPI: 1972610814
Provider Name (Legal Business Name): MATTHEW S PUZIO O.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 ROUTE 134
SOUTH DENNIS MA
02660-3700
US

IV. Provider business mailing address

300 BUCK ISLAND RD APT 14J
W YARMOUTH MA
02673-2590
US

V. Phone/Fax

Practice location:
  • Phone: 508-394-2211
  • Fax:
Mailing address:
  • Phone: 508-360-0491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4572
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: