Provider Demographics
NPI:1316202112
Name:KOSTER, ALYSSA (OD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:KOSTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 WARNER ST
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9632
Mailing Address - Country:US
Mailing Address - Phone:517-285-1408
Mailing Address - Fax:
Practice Address - Street 1:12371 JAMES ST STE 20
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7618
Practice Address - Country:US
Practice Address - Phone:616-294-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist