Provider Demographics
NPI:1760445993
Name:MAZEAS, DINA (OD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:MAZEAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 KEY COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5300
Mailing Address - Country:US
Mailing Address - Phone:703-369-1302
Mailing Address - Fax:703-369-9732
Practice Address - Street 1:9150 KEY COMMONS CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5300
Practice Address - Country:US
Practice Address - Phone:703-369-1302
Practice Address - Fax:703-369-9732
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000090152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU13086Medicare UPIN