Healthcare Provider Details

I. General information

NPI: 1922204163
Provider Name (Legal Business Name): DAVID JOSEPH BOZAK COHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 02/25/2022
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 POLARIS ST BLDG 586
VIRGINIA BEACH VA
23461-1935
US

IV. Provider business mailing address

472 POLARIS ST BLDG 586
VIRGINIA BEACH VA
23461-1935
US

V. Phone/Fax

Practice location:
  • Phone: 757-862-0071
  • Fax: 757-862-0082
Mailing address:
  • Phone: 757-862-0071
  • Fax: 757-862-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: