=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063304178
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATARINA JENELLE KOZER OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2025
-----------------------------------------------------
Last Update Date | 07/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2094 ALBANY POST RD
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10548-1454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-737-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 FIFTH AVE APT 54
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10803-1561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-367-9718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 011200
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------