Provider Demographics
NPI:1396185427
Name:PABISZ, TRISTA (OD)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:PABISZ
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 1:48187 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-3268
Mailing Address - Country:US
Mailing Address - Phone:586-739-9550
Mailing Address - Fax:586-739-0083
Practice Address - Street 1:48187 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317-3268
Practice Address - Country:US
Practice Address - Phone:586-739-9550
Practice Address - Fax:586-739-0083
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist