Provider Demographics
NPI:1083969034
Name:MARTIN, ELIZABETH MAUZY (OD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MAUZY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:MAUZY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4139
Mailing Address - Country:US
Mailing Address - Phone:270-685-4966
Mailing Address - Fax:270-686-8058
Practice Address - Street 1:221 ALLEN ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4139
Practice Address - Country:US
Practice Address - Phone:270-685-4966
Practice Address - Fax:270-686-8058
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1884DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist