Provider Demographics
NPI:1003995747
Name:KOSNOSKI EYE CARE INC
Entity Type:Organization
Organization Name:KOSNOSKI EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOSNOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-852-2020
Mailing Address - Street 1:10002 SE 240TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-4839
Mailing Address - Country:US
Mailing Address - Phone:253-852-2020
Mailing Address - Fax:253-854-2020
Practice Address - Street 1:10002 SE 240TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-4839
Practice Address - Country:US
Practice Address - Phone:253-852-2020
Practice Address - Fax:253-854-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADF8532OtherRAILROAD MEDICARE
WA1021416Medicaid
WA1012250Medicaid
WA1006117Medicaid
WA1021416Medicaid
WA1012250Medicaid
WAG8863121Medicare PIN
WA5819440002Medicare NSC