Provider Demographics
NPI:1417086331
Name:MOZLIN, BARRY R (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:R
Last Name:MOZLIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 S EL CAMINO REAL STE A
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4141
Mailing Address - Country:US
Mailing Address - Phone:760-944-7177
Mailing Address - Fax:760-944-9603
Practice Address - Street 1:205 S EL CAMINO REAL STE A
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4141
Practice Address - Country:US
Practice Address - Phone:760-944-7177
Practice Address - Fax:760-944-9603
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6516T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY2074Medicare PIN
CAOP6516TMedicare UPIN