Provider Demographics
NPI:1710161773
Name:PETER J KAZANOVICZ
Entity Type:Organization
Organization Name:PETER J KAZANOVICZ
Other - Org Name:D/B/A STUDLEY OCULAR LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CERTIFIED OCULARIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAZANOVICZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:603-622-5200
Mailing Address - Street 1:169 S RIVER RD
Mailing Address - Street 2:UNIT 14A
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6971
Mailing Address - Country:US
Mailing Address - Phone:603-622-5200
Mailing Address - Fax:603-644-2354
Practice Address - Street 1:1685 CONGRESS STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2776
Practice Address - Country:US
Practice Address - Phone:207-772-1467
Practice Address - Fax:603-644-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME141840000Medicaid
ME141840000Medicaid