Provider Demographics
NPI:1629246400
Name:DR. MELVYN S MAZER
Entity Type:Organization
Organization Name:DR. MELVYN S MAZER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELVYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-268-3366
Mailing Address - Street 1:940 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4588
Mailing Address - Country:US
Mailing Address - Phone:203-268-3366
Mailing Address - Fax:
Practice Address - Street 1:940 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4588
Practice Address - Country:US
Practice Address - Phone:203-268-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000220Medicare PIN
CT0622770001Medicare NSC