Provider Demographics
NPI:1881785467
Name:COZZA OPTICAL INC
Entity type:Organization
Organization Name:COZZA OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:I
Authorized Official - Last Name:COZZA
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:509-489-2020
Mailing Address - Street 1:5503 N WALL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6402
Mailing Address - Country:US
Mailing Address - Phone:509-489-2020
Mailing Address - Fax:509-489-3387
Practice Address - Street 1:5503 N WALL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6402
Practice Address - Country:US
Practice Address - Phone:509-489-2020
Practice Address - Fax:509-489-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA548156FX1800X
WA1954156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022986Medicaid
WA1275820001Medicare NSC