Provider Demographics
NPI:1679699243
Name:KOZARSKY, TOD A (OD)
Entity Type:Individual
Prefix:DR
First Name:TOD
Middle Name:A
Last Name:KOZARSKY
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 1:972 MANOR AVE.
Mailing Address - Street 2:
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1324
Mailing Address - Country:US
Mailing Address - Phone:215-500-1578
Mailing Address - Fax:215-572-6308
Practice Address - Street 1:2250 CHEMICAL RD
Practice Address - Street 2:TARGET OPTICAL
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1716
Practice Address - Country:US
Practice Address - Phone:610-276-0045
Practice Address - Fax:610-276-0047
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET009021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396928OtherNATIONAL VISION ADMINISTR
PA90463OtherHIGHMARK
PA397170OtherNATIONAL VISION ADMINISTR
PA397253OtherNATIONAL VISION ADMINISTR
PA00862590Medicaid
PA50154OtherAETNA
PA396928OtherNATIONAL VISION ADMINISTR