Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 35-05-5038 | OH |
NPI | 1023004983 |
---|---|
Provider Name | George W Rozakis |
First Address | Lakewood, OH 44107-1018 |
Second Address | Westlake, OH 44145-5222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 18/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0655189 | (05) | OH |
A16827 | (02) | OH |