Provider Demographics
NPI:1326218215
Name:TAD R KOSANOVICH OD PA
Entity Type:Organization
Organization Name:TAD R KOSANOVICH OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOSANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-473-1392
Mailing Address - Street 1:150 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-3307
Mailing Address - Country:US
Mailing Address - Phone:941-473-1392
Mailing Address - Fax:941-473-9379
Practice Address - Street 1:150 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3307
Practice Address - Country:US
Practice Address - Phone:941-473-1392
Practice Address - Fax:941-473-9379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
4214080001Medicare NSC