Provider Demographics
NPI:1477549764
Name:KOSUNICK, JOSEPHINE MANGONI (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:MANGONI
Last Name:KOSUNICK
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 1:1261 W ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2407
Mailing Address - Country:US
Mailing Address - Phone:440-526-7070
Mailing Address - Fax:
Practice Address - Street 1:1261 W ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2407
Practice Address - Country:US
Practice Address - Phone:440-526-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000282518OtherANTHEM BC/BS PROVIDER #
OH000000503349OtherANTHEM (PARMA)
OH200669OtherCIGNA (DRS KOSUNICK & SC)
OH2714585Medicaid
OH201924453027OtherCARESOURCE
OH7346559OtherAETNA (WA JONES)
OH000000503347OtherANTHEM (NORTH OLMSTED)
OH270701075006OtherMEDICAL MUTUAL (PARMA)
OH7346559OtherAETNA
OHR5326OtherSUMMA HEALTH
OH2006698OtherCIGNA HEALTH
OH4092977Medicare PIN
OH000000503347OtherANTHEM (NORTH OLMSTED)
OH7346559OtherAETNA (WA JONES)
OH200669OtherCIGNA (DRS KOSUNICK & SC)
OH2714585Medicaid