Provider Demographics
NPI:1780786749
Name:KOZEL, ROBERT JOEL (MED)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOEL
Last Name:KOZEL
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2919
Mailing Address - Country:US
Mailing Address - Phone:210-832-0734
Mailing Address - Fax:
Practice Address - Street 1:115 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2919
Practice Address - Country:US
Practice Address - Phone:210-832-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ156FX1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric Assistant