Provider Demographics
NPI:1245587294
Name:MAZA OPTICAL LLC
Entity Type:Organization
Organization Name:MAZA OPTICAL LLC
Other - Org Name:PHILADELPHIA EYEGLASS LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-368-1600
Mailing Address - Street 1:752 HORSHAM RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-9617
Mailing Address - Country:US
Mailing Address - Phone:215-368-1600
Mailing Address - Fax:215-368-1605
Practice Address - Street 1:752 HORSHAM RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9617
Practice Address - Country:US
Practice Address - Phone:215-368-1600
Practice Address - Fax:215-368-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000002009332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA744198YBYGMedicare UPIN