Provider Demographics
NPI:1902086630
Name:ROBERT F. JOZWIAK, O.D. INC.
Entity Type:Organization
Organization Name:ROBERT F. JOZWIAK, O.D. INC.
Other - Org Name:NORTHEAST VISION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:JOZWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-882-9131
Mailing Address - Street 1:113 COMMERCE PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6055
Mailing Address - Country:US
Mailing Address - Phone:614-882-9131
Mailing Address - Fax:614-882-9133
Practice Address - Street 1:113 COMMERCE PARK DR STE A
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6055
Practice Address - Country:US
Practice Address - Phone:614-882-9131
Practice Address - Fax:614-882-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2871T504152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH2871OtherEYEMED
OH2200233OtherUNITED HEALTH CARE
OH000000239361OtherANTHEM
OH271403744004OtherMEDICAL MUTUAL
OH5928048OtherAETNA
OHDC8383Medicare PIN
OH000000239361OtherANTHEM
OHOH2871OtherEYEMED
OH9330601Medicare PIN