Provider Demographics
NPI:1235343559
Name:BAZAN, JUSTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:BAZAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 UNION ST
Mailing Address - Street 2:PARK SLOPE EYE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1161
Mailing Address - Country:US
Mailing Address - Phone:347-560-8393
Mailing Address - Fax:888-850-6294
Practice Address - Street 1:682 UNION ST
Practice Address - Street 2:PARK SLOPE EYE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1161
Practice Address - Country:US
Practice Address - Phone:347-560-8393
Practice Address - Fax:888-850-6294
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006867152W00000X
TX8627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist