Healthcare Provider Details

I. General information

NPI: 1770658510
Provider Name (Legal Business Name): MIZ INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15670 EDGEWOOD DR STE 100
BAXTER MN
56401-1530
US

IV. Provider business mailing address

15670 EDGEWOOD DR STE 100
BAXTER MN
56401-1530
US

V. Phone/Fax

Practice location:
  • Phone: 218-828-4024
  • Fax: 218-828-9759
Mailing address:
  • Phone: 218-828-4024
  • Fax: 218-828-9759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER ZIMMERMAN
Title or Position: PRESIDENT
Credential:
Phone: 218-828-4024