Provider Demographics
NPI:1821051319
Name:ROZYCKI, KAREN MARIE (OD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:ROZYCKI
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 1:30 BELLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AVELLA
Mailing Address - State:PA
Mailing Address - Zip Code:15312-2453
Mailing Address - Country:US
Mailing Address - Phone:724-225-4448
Mailing Address - Fax:
Practice Address - Street 1:136 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4423
Practice Address - Country:US
Practice Address - Phone:724-225-4448
Practice Address - Fax:724-225-7237
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007737T152W00000X
PAOE007737-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU63572Medicare UPIN
PA783091GATMedicare ID - Type Unspecified