Healthcare Provider Details

I. General information

NPI: 1184696957
Provider Name (Legal Business Name): ERIK B MAUZY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LIGONIER ST
LATROBE PA
15650-1882
US

IV. Provider business mailing address

1010 LIGONIER ST
LATROBE PA
15650-1882
US

V. Phone/Fax

Practice location:
  • Phone: 724-539-1671
  • Fax: 724-539-1654
Mailing address:
  • Phone: 724-539-1671
  • Fax: 724-539-1654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG000414
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1009331570001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
IdentifierP00433380
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerTRAVELERS MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: