Provider Demographics
NPI:1205908928
Name:WOZNIAK, AMY K (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:WOZNIAK
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 1:137 S LIVERNOIS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1837
Mailing Address - Country:US
Mailing Address - Phone:248-652-0600
Mailing Address - Fax:248-652-2661
Practice Address - Street 1:137 S LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-1837
Practice Address - Country:US
Practice Address - Phone:248-652-0600
Practice Address - Fax:248-652-2661
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4516089Medicaid
MIU72192Medicare UPIN
MI4516089Medicaid