Individual
DR. DONALD S. MAZZULLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4116 W CRAIG RD, #104, NORTH LAS VEGAS, NV 89032
(702) 631-2015
(702) 631-2511
Mailing address
8724 AZURE SKY DR, LAS VEGAS, NV 89129-2223
(702) 631-2015
(702) 631-2511
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0231
NV
207W00000X
Ophthalmology Physician
0231
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194777219
INDIVIDUAL NPI
NV
05
—
OD231
—
NV
Enumeration date
05/17/2006
Last updated
02/02/2011
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