Basic Information
| Provider Information | |||||||||
| NPI: | 1346833159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOZEK | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | KLOFAS | ||||||||
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| Credential: | MD, PHD | ||||||||
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| OtherLastName: | KLOFAS | ||||||||
| OtherFirstName: | LINDSAY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 64 WINDHAM DR | ||||||||
| Address2: | |||||||||
| City: | EAST LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010282668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135194997 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 243 CHARLES ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021143096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175237900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2021 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | PENDING | MA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.