Jacob A Kozisek, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3173 Issued in WI

Practice address

2253 W Mason St
Green Bay, WI 54303-4706

Phone

(920) 327-7000

Fax

(920) 327-7005

NPI assigned

Jul 8, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

86.21 of 100Reported as group

Quality

78.54

Promoting interoperability

100

Improvement activities

40

Cost

75.5

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Baycare Clinic LLP

  • Emergency Medicine Physician
  • Green Bay, WI
  • NPI 1588609648
  Medicare reassignment NPD
• Baycare Clinic LLP

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1134490758
  NPD
• Baycare Clinic LLP

  • Durable Medical Equipment & Medical Supplies
  • Green Bay, WI
  • NPI 1851336242
  NPD (past)

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

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785628800000",
    "number": "1306075635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 KEPLER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118320",
            "telephone_number": "920-490-9046",
            "fax_number": "920-405-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2253 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034706",
            "telephone_number": "920-327-7000",
            "fax_number": "920-327-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZISEK",
        "first_name": "JACOB",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-08",
        "last_updated": "2026-08-02",
        "certification_date": "2026-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkozisek60737@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "2253 W Mason St Ste 100",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543034706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristin C Kouba, MSW, APSW
• Eugeni T Kouzov, M.D.
• Kathleen Mary Kowalke, LPC, CTRS
• Julianne Kowalski
• Jane Elizabeth Kozicki, RN
• Eileen Kozlovsky
• Nicole Kozlovsky
• Danielle Kraak
• Carrie Kraemer, APSW
• Laura Kraft, PA-C

• Optometrist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.