Healthcare Provider Details

I. General information

NPI: 1538276498
Provider Name (Legal Business Name): PATRICIA M WOZNICKI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W MICHIGAN AVE
MARSHALL MI
49068-1446
US

IV. Provider business mailing address

830 W MICHIGAN AVE
MARSHALL MI
49068-1446
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-9822
  • Fax: 269-781-9839
Mailing address:
  • Phone: 269-781-9822
  • Fax: 269-781-9839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003201
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: