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General NPI Number Information
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NPI Number | 1376056978
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Entity Type | Organization
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Legal Business Name | MAZY EYE INC.
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 4000 MONUMENT RD
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1600
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Country | US
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Telephone | 215-220-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 CLYDESDALE CIR
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City | YARDLEY
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State | PA
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Zip | 19067-4114
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Country | US
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Telephone | 609-638-0102
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. QURTULLEAN MALIK
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Credential | OD
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Telephone | 609-638-0102
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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 | OEG003001
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License Number State | PA
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