Provider Demographics
NPI:1437173655
Name:LOZEN, JEFFREY WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:LOZEN
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 1:3360 I 75 BUSINESS SPUR
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3605
Mailing Address - Country:US
Mailing Address - Phone:906-623-7258
Mailing Address - Fax:906-635-0581
Practice Address - Street 1:3360 I 75 BUSINESS SPUR
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3605
Practice Address - Country:US
Practice Address - Phone:906-623-7258
Practice Address - Fax:906-635-0581
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901-002917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382430702OtherVSP SAULT VISION CLINIC
MI5106263Medicaid
MI900A77777OtherBCBS SAULT VISION CLINIC
MIU24276Medicare UPIN
MI5106263Medicaid