{
"Npi": {
"NPI": "1568251700",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KOZICZKOWSKI",
"FirstName": "EMILY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OD, MS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "345 COLLEGE ST SE STE C",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LACEY",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98503-1014",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "360-456-3200",
"MailingAddressFaxNumber": "360-456-3894",
"FirstLinePracticeLocationAddress": "6300 SAWMILL RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DUBLIN",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43017-1470",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "614-726-7256",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/05/2025",
"LastUpdateDate": "10/07/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "INPROGRESS",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}