Provider Demographics
NPI:1306710488
Name:JESSE BEN MIZE III & CHRISTIE MIZE PTR
Entity type:Organization
Organization Name:JESSE BEN MIZE III & CHRISTIE MIZE PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:BEN
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:304-273-2020
Mailing Address - Street 1:3104 JACKSON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-1767
Mailing Address - Country:US
Mailing Address - Phone:304-675-4580
Mailing Address - Fax:
Practice Address - Street 1:3104 JACKSON AVE STE B
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1767
Practice Address - Country:US
Practice Address - Phone:304-675-4580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty