Provider Demographics
NPI:1851476865
Name:VAZAGOV, KOZUR IRENE (OD)
Entity Type:Individual
Prefix:DR
First Name:KOZUR
Middle Name:IRENE
Last Name:VAZAGOV
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 1:488 E SANTA CLARA ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7229
Mailing Address - Country:US
Mailing Address - Phone:626-357-2020
Mailing Address - Fax:626-357-9020
Practice Address - Street 1:488 E SANTA CLARA ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7229
Practice Address - Country:US
Practice Address - Phone:626-357-2020
Practice Address - Fax:626-357-9020
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10433T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954509552OtherBLUE CROSS
CA54220SD0104330OtherBLUE SHIELD
CAWY054Medicare ID - Type Unspecified