Healthcare Provider Details

I. General information

NPI: 1649467820
Provider Name (Legal Business Name): COZZA OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W RIVERSIDE AVE SUITE 102
SPOKANE WA
99201-0405
US

IV. Provider business mailing address

421 W RIVERSIDE AVE SUITE 102
SPOKANE WA
99201-0405
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-9209
  • Fax:
Mailing address:
  • Phone: 509-624-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: BARBARA COZZA
Title or Position: VP
Credential: LDO
Phone: 509-489-2020