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General NPI Number Information
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NPI Number | 1730500117
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Entity Type | Individual
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Provider Name | WALTER MAZEIKO JR. HAS
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Gender | Male
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 2221C TAMIAMI TRL SUITE #C
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-2104
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Country | US
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Telephone | 941-625-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 2221C TAMIAMI TRL UNIT 5-260
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-2104
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Country | US
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Telephone | 941-625-3366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AS 4984
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License Number State | FL
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