Healthcare Provider Details

I. General information

NPI: 1922459981
Provider Name (Legal Business Name): DANIELLE ROSE COZZA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LINCOLN AVE
NORTH CHARLEROI PA
15022-2422
US

IV. Provider business mailing address

1683 VILLAGE GREEN DR
CLAIRTON PA
15025-3050
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-8055
  • Fax:
Mailing address:
  • Phone: 570-772-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003201
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: