=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639127921
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE CARE FOR YOU INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 01/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2250 CHEMICAL RD TARGET OPTICAL
-----------------------------------------------------
City | PLYMOUTH MEETING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19462-1716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-276-0045
-----------------------------------------------------
Fax | 610-276-0047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 972 MANOR AVE
-----------------------------------------------------
City | MEADOWBROOK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19046-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-500-1578
-----------------------------------------------------
Fax | 215-572-6308
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | 0WNER
-----------------------------------------------------
Name | DR. TOD A KOZARSKY
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 215-500-1578
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OET009021
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------