Provider Demographics
NPI:1871578054
Name:MAZIE, BRUCE (OD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:MAZIE
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 1:1020 ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2437
Mailing Address - Country:US
Mailing Address - Phone:973-777-9296
Mailing Address - Fax:972-777-9297
Practice Address - Street 1:1020 ROUTE 46
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2437
Practice Address - Country:US
Practice Address - Phone:973-777-9296
Practice Address - Fax:972-777-9297
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU35526Medicare UPIN
NJ087654Medicare ID - Type Unspecified