Provider Demographics
NPI:1730519422
Name:DR. MOZLIN
Entity type:Organization
Organization Name:DR. MOZLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOZLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-944-7177
Mailing Address - Street 1:205 S EL CAMINO REAL STE A
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4141
Mailing Address - Country:US
Mailing Address - Phone:760-944-7177
Mailing Address - Fax:
Practice Address - Street 1:205 S EL CAMINO REAL STE A
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4141
Practice Address - Country:US
Practice Address - Phone:760-944-9601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARRY R. MOZLIN, O.D., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6516T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10345Medicare UPIN