Provider Demographics
NPI:1598887267
Name:MIZERAK, STEVEN GARY I (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GARY
Last Name:MIZERAK
Suffix:I
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 1:26 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1200
Mailing Address - Country:US
Mailing Address - Phone:508-829-0894
Mailing Address - Fax:
Practice Address - Street 1:7 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2794
Practice Address - Country:US
Practice Address - Phone:508-856-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3626OtherMA LICENSE NUMBER