Provider Demographics
NPI:1194955310
Name:COZZI, NANCY (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:COZZI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 NEW MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272-9780
Mailing Address - Country:US
Mailing Address - Phone:314-477-7278
Mailing Address - Fax:
Practice Address - Street 1:512 CANTON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-2530
Practice Address - Country:US
Practice Address - Phone:330-784-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009020663152W00000X
IL046.010230152W00000X
OH6349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0485517Medicaid