Provider Demographics
NPI:1245215748
Name:BOKOSKY, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BOKOSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3939 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3002
Mailing Address - Country:US
Mailing Address - Phone:619-296-8525
Mailing Address - Fax:619-692-0229
Practice Address - Street 1:3939 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3002
Practice Address - Country:US
Practice Address - Phone:619-296-8525
Practice Address - Fax:619-692-0229
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2022-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG51651207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051011AOtherMEDICARE
CA00G516510Medicaid
CAS051011AOtherMEDICARE
A52046Medicare UPIN