Provider Demographics
NPI:1528873635
Name:VIZAM, FAYAZ YAHIYA (OD)
Entity type:Individual
Prefix:DR
First Name:FAYAZ
Middle Name:YAHIYA
Last Name:VIZAM
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 1:400 COMMONS WAY STE 327
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2822
Mailing Address - Country:US
Mailing Address - Phone:908-704-8855
Mailing Address - Fax:
Practice Address - Street 1:400 COMMONS WAY STE 327
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2822
Practice Address - Country:US
Practice Address - Phone:908-704-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00734000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist