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General NPI Number Information
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NPI Number | 1811346554
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Entity Type | Organization
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Legal Business Name | MAZZARE VISION GROUP, PLLC
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 1002 E WYANDOTTE AVE
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City | MCALESTER
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State | OK
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Zip | 74501-5434
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Country | US
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Telephone | 918-426-0106
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Fax | 918-426-0443
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Provider Business Mailing Address
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Address Line | 1002 E WYANDOTTE AVE
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City | MCALESTER
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State | OK
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Zip | 74501
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Country | US
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Telephone | 918-426-0106
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Fax | 918-426-0443
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | ANDREA NICOLE MAZZARE
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Credential | OD
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Telephone | 918-426-0106
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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 | 2618
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License Number State | OK
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