Healthcare Provider Details

I. General information

NPI: 1184543548
Provider Name (Legal Business Name): PATRICIA KOZAK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 SW FREWING ST STE 130
TIGARD OR
97223-5091
US

IV. Provider business mailing address

9975 SW FREWING ST STE 130
TIGARD OR
97223-5091
US

V. Phone/Fax

Practice location:
  • Phone: 503-906-3596
  • Fax:
Mailing address:
  • Phone: 503-906-3596
  • Fax: 503-906-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2848AT
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: