Healthcare Provider Details

I. General information

NPI: 1114954328
Provider Name (Legal Business Name): FRANK DONALD KOZIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8212 TELEGRAPH RD
TAYLOR MI
48180-2229
US

IV. Provider business mailing address

6245 WILLOW CT
WEST BLOOMFIELD MI
48324-2043
US

V. Phone/Fax

Practice location:
  • Phone: 313-291-7450
  • Fax:
Mailing address:
  • Phone: 248-363-6405
  • Fax: 248-363-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002110
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: