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General NPI Number Information
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NPI Number | 1316095482
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Entity Type | Organization
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Legal Business Name | MAZ OPTICAL, INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 655 MONTAUK HIGHWAY SUITE 29
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772
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Country | US
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Telephone | 631-447-1300
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Fax | 631-447-1302
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Provider Business Mailing Address
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Address Line | 655 MONTAUK HWY SUITE 29
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4733
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Country | US
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Telephone | 631-447-1300
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Fax | 631-447-1302
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARILYN A PEPPERS
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Credential |
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Telephone | 631-447-1300
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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 | VUT003894
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 5877-1
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License Number State | NY
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