MEDICARE: CHRISTINE R MIZE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	931-OD	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235104480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE R MIZE O.D.

Provider Business Mailing Address
First Line	:	706 WASHINGTON ST
Second Line	:
City	:	RAVENSWOOD
State	:	WV
Zip	:	26164-1772
Country	:	US
Telephone Number	:	304-273-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	706 WASHINGTON ST
Second Line	:
City	:	RAVENSWOOD
State	:	WV
Zip	:	26164-1772
Country	:	US
Telephone Number	:	304-273-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	02/12/2010

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