Provider Demographics
NPI:1023744182
Name:OIC INTEGRATIVE OPTOMETRY LLC
Entity type:Organization
Organization Name:OIC INTEGRATIVE OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:COZZI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-477-7278
Mailing Address - Street 1:4602 NEW MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272-9780
Mailing Address - Country:US
Mailing Address - Phone:314-477-7278
Mailing Address - Fax:
Practice Address - Street 1:812 HURON RD E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1123
Practice Address - Country:US
Practice Address - Phone:216-781-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0485517Medicaid