Healthcare Provider Details

I. General information

NPI: 1205908928
Provider Name (Legal Business Name): AMY K WOZNIAK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 S LIVERNOIS RD
ROCHESTER HILLS MI
48307-1837
US

IV. Provider business mailing address

137 S LIVERNOIS RD
ROCHESTER HILLS MI
48307-1837
US

V. Phone/Fax

Practice location:
  • Phone: 248-652-0600
  • Fax: 248-652-2661
Mailing address:
  • Phone: 248-652-0600
  • Fax: 248-652-2661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003787
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: