Provider Demographics
NPI:1629020219
Name:OZER, GEORGE EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:OZER
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 1:2316 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3408
Mailing Address - Country:US
Mailing Address - Phone:610-485-1500
Mailing Address - Fax:
Practice Address - Street 1:2316 MEETINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:BOOTHWYN
Practice Address - State:PA
Practice Address - Zip Code:19061-3408
Practice Address - Country:US
Practice Address - Phone:610-485-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0004501144OtherAETNA
PA0010100390003Medicaid
PA9708184OtherAETNA
PA2028701OtherHIGHMARK BLUE SHIELD
PAP00625100OtherRAILROAD MEDICARE
PA0033171000OtherINDEPENDENCE BLUE CROSS
PA843647OtherADVANTRA FREEDOM
PA0033171000OtherINDEPENDENCE BLUE CROSS
PA9708184OtherAETNA
PA0525810001Medicare NSC