Provider Demographics
NPI:1568774271
Name:KOZA, CYNTHIA A (OD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:KOZA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 COX ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060
Mailing Address - Country:US
Mailing Address - Phone:804-270-0330
Mailing Address - Fax:804-270-1003
Practice Address - Street 1:4600 COX ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-270-0330
Practice Address - Fax:804-270-1003
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist