Provider Demographics
NPI:1023156965
Name:CORZINE, JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:CORZINE
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 1:200 MINOR HALL
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-2020
Mailing Address - Country:US
Mailing Address - Phone:510-643-2793
Mailing Address - Fax:510-643-5109
Practice Address - Street 1:200 MINOR HALL
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-2020
Practice Address - Country:US
Practice Address - Phone:510-643-2793
Practice Address - Fax:510-643-5109
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9875 TPL152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0098750Medicaid
SD0098750Medicare ID - Type Unspecified
CASD0098750Medicaid