Provider Demographics
NPI:1316095482
Name:MAZ OPTICAL, INC
Entity type:Organization
Organization Name:MAZ OPTICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEPPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-447-1300
Mailing Address - Street 1:655 MONTAUK HWY
Mailing Address - Street 2:SUITE 29
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4733
Mailing Address - Country:US
Mailing Address - Phone:631-447-1300
Mailing Address - Fax:631-447-1302
Practice Address - Street 1:655 MONTAUK HIGHWAY
Practice Address - Street 2:SUITE 29
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-447-1300
Practice Address - Fax:631-447-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003894152W00000X
NY5877-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5400044OtherGHI
333670OtherNVA
NYU19870Medicare UPIN
333670OtherNVA
NY0265360001Medicare NSC