Provider Demographics
NPI:1235221037
Name:VIZMULLER, MARCELA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARCELA
Middle Name:
Last Name:VIZMULLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3644
Mailing Address - Country:US
Mailing Address - Phone:440-232-3615
Mailing Address - Fax:
Practice Address - Street 1:767 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3644
Practice Address - Country:US
Practice Address - Phone:440-232-3615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0399706Medicaid
OHT47079Medicare UPIN
OHVI0469011Medicare ID - Type Unspecified