Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1101X | Ophthalmic Assistant | ||
N | 156FX1202X | Optometric Technician |
NPI | 1922204163 |
---|---|
Provider Name | Mr. David Joseph Bozak |
First Address | Virginia Beach, VA 23461-2200 |
Second Address | Virginia Beach, VA 23461-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 01/05/2009 |