Provider Demographics
NPI:1023004983
Name:ROZAKIS, GEORGE W (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:ROZAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1018
Mailing Address - Country:US
Mailing Address - Phone:440-777-2667
Mailing Address - Fax:440-835-2266
Practice Address - Street 1:29111 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5222
Practice Address - Country:US
Practice Address - Phone:440-777-2667
Practice Address - Fax:440-835-2266
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-5038207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0655189Medicaid
OH0655189Medicaid
OHA16827Medicare UPIN