Healthcare Provider Details

I. General information

NPI: 1568251700
Provider Name (Legal Business Name): EMILY KOZICZKOWSKI OD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 SAWMILL RD
DUBLIN OH
43017-1470
US

IV. Provider business mailing address

345 COLLEGE ST SE STE C
LACEY WA
98503-1014
US

V. Phone/Fax

Practice location:
  • Phone: 614-726-7256
  • Fax:
Mailing address:
  • Phone: 360-456-3200
  • Fax: 360-456-3894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberINPROGRESS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: