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General NPI Number Information
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NPI Number | 1306710488
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Entity Type | Organization
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Legal Business Name | JESSE BEN MIZE III & CHRISTIE MIZE PTR
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 3104 JACKSON AVE STE B
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City | POINT PLEASANT
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State | WV
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Zip | 25550-1767
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Country | US
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Telephone | 304-675-4580
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Fax |
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Provider Business Mailing Address
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Address Line | 3104 JACKSON AVE STE B
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City | POINT PLEASANT
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State | WV
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Zip | 25550-1767
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Country | US
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Telephone | 304-675-4580
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSE BEN MIZE III
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Credential | OD
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Telephone | 304-273-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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