Provider Demographics
NPI:1962248773
Name:BIZUB, DOMINIKA (OD)
Entity type:Individual
Prefix:DR
First Name:DOMINIKA
Middle Name:
Last Name:BIZUB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 COOLIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1378
Mailing Address - Country:US
Mailing Address - Phone:517-337-0316
Mailing Address - Fax:517-337-1779
Practice Address - Street 1:1535 E BROOMFIELD ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4489
Practice Address - Country:US
Practice Address - Phone:989-772-3339
Practice Address - Fax:989-772-4846
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901005767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist