MEDICARE: OIC INTEGRATIVE OPTOMETRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023744182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OIC INTEGRATIVE OPTOMETRY LLC

Provider Business Mailing Address
First Line	:	4602 NEW MILFORD RD
Second Line	:
City	:	ROOTSTOWN
State	:	OH
Zip	:	44272-9780
Country	:	US
Telephone Number	:	314-477-7278
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 HURON RD E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1123
Country	:	US
Telephone Number	:	216-781-7900
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. NANCY COZZI
Credential	:	OD
Telephone Number	:	314-477-7278

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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