Organization
ELLEN KOZOB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN R KOZOB O.D. (OWNER)
(224) 622-0907
Entity
Organization
Contact information
Practice address
2131 N LARRABEE ST, UNIT 6107, CHICAGO, IL 60614-4444
(224) 622-0907
Mailing address
2131 N LARRABEE ST, UNIT 6107, CHICAGO, IL 60614-4444
(224) 622-0907
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010698
IL
Other
Enumeration date
07/24/2015
Last updated
07/24/2015
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