Individual
MARTIN W MIZENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4353 DODGE ST, OMAHA, NE 68131-2709
(402) 552-2020
Mailing address
4353 DODGE ST, OMAHA, NE 68131-2709
(402) 552-2020
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
20146
NE
207W00000X
Ophthalmology Physician
29056
IA
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
20146
NE
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
29056
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47080542812
—
NE
Enumeration date
11/16/2005
Last updated
09/10/2021
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