1679699243 NPI number — DR. TOD A KOZARSKY O.D.

Table of content: DR. TOD A KOZARSKY O.D. (NPI 1679699243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679699243 NPI number — DR. TOD A KOZARSKY O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOZARSKY
Provider First Name:
TOD
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679699243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
972 MANOR AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEADOWBROOK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19046-1324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-500-1578
Provider Business Mailing Address Fax Number:
215-572-6308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 CHEMICAL RD
Provider Second Line Business Practice Location Address:
TARGET OPTICAL
Provider Business Practice Location Address City Name:
PLYMOUTH MEETING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19462-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-276-0045
Provider Business Practice Location Address Fax Number:
610-276-0047
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OET009021 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 396928 . This is a "NATIONAL VISION ADMINISTR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 90463 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 397170 . This is a "NATIONAL VISION ADMINISTR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 397253 . This is a "NATIONAL VISION ADMINISTR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00862590 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50154 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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