Healthcare Provider Details

I. General information

NPI: 1629232632
Provider Name (Legal Business Name): WARREN T MEZGER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FULLER ST RIVER HOSPITAL
ALEXANDRIA BAY NY
13607-1316
US

IV. Provider business mailing address

4 FULLER ST RIVER HOSPITAL
ALEXANDRIA BAY NY
13607-1316
US

V. Phone/Fax

Practice location:
  • Phone: 941-661-2694
  • Fax:
Mailing address:
  • Phone: 941-661-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002772-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number002772-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: