Provider Demographics
NPI:1861470569
Name:MAZER, MELVYN S (OD)
Entity Type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:S
Last Name:MAZER
Suffix:
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 1:940 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:203-268-2891
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:203-268-2891
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000220Medicare PIN
CT0622770001Medicare NSC