Provider Demographics
NPI:1659387017
Name:KOZIOL-THOMS EYE ASSOCIATES S.C.
Entity Type:Organization
Organization Name:KOZIOL-THOMS EYE ASSOCIATES S.C.
Other - Org Name:ADVANCED EYE CARE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOZIOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-259-2777
Mailing Address - Street 1:1211 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3142
Mailing Address - Country:US
Mailing Address - Phone:847-259-2777
Mailing Address - Fax:847-437-6841
Practice Address - Street 1:1211 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3142
Practice Address - Country:US
Practice Address - Phone:847-259-2777
Practice Address - Fax:847-437-6841
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOZIOL-THOMS EYE ASSOCIATES SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0607520001Medicare ID - Type Unspecified