Ellen Kozob, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010698 Issued in IL

Legal business name

ELLEN KOZOB, INC

Practice address

2131 N Larrabee St
Unit 6107
Chicago, IL 60614-4444

Phone

(224) 622-0907

NPI assigned

Jul 24, 2015

Last updated

Jul 24, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ellen R Kozob, O.D.

Title

Owner

Phone

(224) 622-0907

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437696000000",
    "number": "1184009730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2131 N LARRABEE ST",
            "address_2": "UNIT 6107",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606144444",
            "telephone_number": "224-622-0907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 N LARRABEE ST",
            "address_2": "UNIT 6107",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606144444",
            "telephone_number": "224-622-0907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN KOZOB, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-24",
        "last_updated": "2015-07-24",
        "status": "A",
        "authorized_official_last_name": "KOZOB",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "224-622-0907",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.