Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | FL1513 | FL |
NPI | 1194869339 |
---|---|
Provider Name | Mr. Steven I Mazlin |
First Address | Titusville, FL 32780-5492 |
Second Address | Titusville, FL 32780-5492 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D6901 | (02) | FL |