Provider Demographics
NPI:1003968041
Name:SHARKEY-KOKOSKY,O.D.,P.C.
Entity Type:Organization
Organization Name:SHARKEY-KOKOSKY,O.D.,P.C.
Other - Org Name:ANGELLO, SHARKEY & KOKOSKY, O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-262-2091
Mailing Address - Street 1:1935 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1362
Mailing Address - Country:US
Mailing Address - Phone:610-262-2091
Mailing Address - Fax:610-262-2239
Practice Address - Street 1:1935 CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1362
Practice Address - Country:US
Practice Address - Phone:610-262-2091
Practice Address - Fax:610-262-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000244152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3118323OtherUSHC
PAAN1430980OtherBLUE SHIELD
PA02916500OtherCAPITAL BLUE CROSS
PA4915190001Medicare NSC
PA065964Medicare ID - Type Unspecified
PAAN1430980OtherBLUE SHIELD
PA3118323OtherUSHC