Provider Demographics
NPI:1114061066
Name:KOCHINSKY, CLIFTON JOSEPH (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:JOSEPH
Last Name:KOCHINSKY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:CLIFTON
Other - Middle Name:JOSEPH
Other - Last Name:KOCHINSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:5600 MYKAWA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-1045
Mailing Address - Country:US
Mailing Address - Phone:713-645-7165
Mailing Address - Fax:713-242-9096
Practice Address - Street 1:5600 MYKAWA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-1045
Practice Address - Country:US
Practice Address - Phone:713-242-9050
Practice Address - Fax:713-242-9096
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29567156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0661696-01Medicaid