Provider Demographics
NPI:1700880564
Name:KAZ, MAURICE (OD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:KAZ
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 1:320 H ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5834
Mailing Address - Country:US
Mailing Address - Phone:530-743-4453
Mailing Address - Fax:530-743-0427
Practice Address - Street 1:8120 TIMBERLAKE WAY
Practice Address - Street 2:STE 211
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5414
Practice Address - Country:US
Practice Address - Phone:916-423-2134
Practice Address - Fax:916-423-4477
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT4440TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDO044400Medicare ID - Type Unspecified
CAU61243Medicare UPIN