Provider Demographics
NPI:1679773055
Name:MEZBUR, DZEJNA
Entity Type:Individual
Prefix:
First Name:DZEJNA
Middle Name:
Last Name:MEZBUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3182
Mailing Address - Country:US
Mailing Address - Phone:630-789-6700
Mailing Address - Fax:815-756-5603
Practice Address - Street 1:1630 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3182
Practice Address - Country:US
Practice Address - Phone:630-789-6700
Practice Address - Fax:815-756-5603
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist