Provider Demographics
NPI:1376056978
Name:MAZY EYE INC.
Entity Type:Organization
Organization Name:MAZY EYE INC.
Other - Org Name:PREMIER FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:QURTULLEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-638-0102
Mailing Address - Street 1:1705 CLYDESDALE CIR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4114
Mailing Address - Country:US
Mailing Address - Phone:609-638-0102
Mailing Address - Fax:
Practice Address - Street 1:4000 MONUMENT RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1600
Practice Address - Country:US
Practice Address - Phone:215-220-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003001152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty