1538276498 NPI number — DR. PATRICIA M WOZNICKI O.D.

Table of content: DR. PATRICIA M WOZNICKI O.D. (NPI 1538276498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538276498 NPI number — DR. PATRICIA M WOZNICKI O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOZNICKI
Provider First Name:
PATRICIA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538276498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 W MICHIGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHALL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49068-1446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-781-9822
Provider Business Mailing Address Fax Number:
269-781-9839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 W MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49068-1446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-781-9822
Provider Business Practice Location Address Fax Number:
269-781-9839
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901003201 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2220022 . This is a "PHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 30416 . This is a "HEALTH PLAN OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 944630181 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: MI3201 . This is a "EYEMED" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: SC1628189 . This is a "CLARITY VISION" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 230886 . This is a "NVA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 900A311030 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 24032 . This is a "SPECTERA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00232105 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5348270002 . This is a "ADMINISTAR FEDERAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: VC380005 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5176293981 . This is a "VSP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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