Individual
JESSE BEN MIZE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
706 WASHINGTON ST, RAVENSWOOD, WV 26164-1772
(304) 273-2020
Mailing address
706 WASHINGTON ST, RAVENSWOOD, WV 26164-1772
(304) 273-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
924-OD
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0149760000
—
WV
Enumeration date
02/23/2006
Last updated
02/12/2010
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