Provider Demographics
NPI:1841654803
Name:DRIZIK, BORIS (OD)
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:DRIZIK
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 1:601 DONALD LYNCH BLVD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4730
Mailing Address - Country:US
Mailing Address - Phone:508-481-8279
Mailing Address - Fax:
Practice Address - Street 1:601 DONALD LYNCH BLVD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4730
Practice Address - Country:US
Practice Address - Phone:508-481-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist