Healthcare Provider Details

I. General information

NPI: 1588692529
Provider Name (Legal Business Name): MAZZUCA EYE AND LASER CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 N BROADWAY
PENNSVILLE NJ
08070-1754
US

IV. Provider business mailing address

48 N BROADWAY
PENNSVILLE NJ
08070-1754
US

V. Phone/Fax

Practice location:
  • Phone: 856-678-4800
  • Fax:
Mailing address:
  • Phone: 856-678-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MS. WENDY ANN MARANDOLA
Title or Position: OFFICE MANAGER
Credential:
Phone: 856-678-4800