Provider Demographics
NPI:1225007651
Name:KOSVITCH, PHILIP A (OD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:KOSVITCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 BUTLER PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1560
Mailing Address - Country:US
Mailing Address - Phone:215-836-1290
Mailing Address - Fax:215-233-3421
Practice Address - Street 1:4060 BUTLER PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1560
Practice Address - Country:US
Practice Address - Phone:215-836-1290
Practice Address - Fax:215-233-3421
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000073152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011172400006Medicaid
PAU74942Medicare UPIN
PA026765H8CMedicare ID - Type Unspecified