Provider Demographics
NPI:1255615621
Name:MOZDEN FAMILY OPTICAL LLC
Entity type:Organization
Organization Name:MOZDEN FAMILY OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOZDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-889-9887
Mailing Address - Street 1:7 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2915
Mailing Address - Country:US
Mailing Address - Phone:860-889-9887
Mailing Address - Fax:860-859-9535
Practice Address - Street 1:7 CLINIC DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2915
Practice Address - Country:US
Practice Address - Phone:860-889-9887
Practice Address - Fax:860-859-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001708332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment