Healthcare Provider Details

I. General information

NPI: 1215644372
Provider Name (Legal Business Name): ANNIKA COZAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 FISHERVILLE RD
CONCORD NH
03303-4010
US

IV. Provider business mailing address

217 FISHERVILLE RD
CONCORD NH
03303-4010
US

V. Phone/Fax

Practice location:
  • Phone: 603-753-2085
  • Fax:
Mailing address:
  • Phone: 603-753-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1128
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: