Provider Demographics
NPI:1447429287
Name:KOSMOS NATIONAL OPTICAL, INC.
Entity Type:Organization
Organization Name:KOSMOS NATIONAL OPTICAL, INC.
Other - Org Name:KOSMOS KIDS, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOSMOS
Authorized Official - Suffix:
Authorized Official - Credentials:NCLC
Authorized Official - Phone:312-726-4090
Mailing Address - Street 1:111 N WABASH AVE
Mailing Address - Street 2:1001
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1903
Mailing Address - Country:US
Mailing Address - Phone:312-726-4090
Mailing Address - Fax:312-726-9190
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:1001
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1903
Practice Address - Country:US
Practice Address - Phone:312-726-4090
Practice Address - Fax:312-726-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier