MEDICARE: MR. ROBERT JOEL KOZEL M.ED.

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	156FX1201X	Optometric Assistant Technician		AZ

General Provider Information

NPI Number	:	1780786749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JOEL KOZEL M.ED.

Provider Business Mailing Address
First Line	:	115 NORTHRIDGE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2919
Country	:	US
Telephone Number	:	210-832-0734
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 NORTHRIDGE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2919
Country	:	US
Telephone Number	:	210-832-0734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/08/2007

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