Healthcare Provider Details

I. General information

NPI: 1306533781
Provider Name (Legal Business Name): CINDY LOU MIZER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 BLUEBELL DR SW
NEW PHILADELPHIA OH
44663-9601
US

IV. Provider business mailing address

231 BLUEBELL DR SW
NEW PHILADELPHIA OH
44663-9601
US

V. Phone/Fax

Practice location:
  • Phone: 330-339-6016
  • Fax: 330-339-6016
Mailing address:
  • Phone: 330-339-6016
  • Fax: 330-339-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.005004-SC
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: