Provider Demographics
NPI:1487030631
Name:KOSIN, JANE SONG (OD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:SONG
Last Name:KOSIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2706
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-2706
Mailing Address - Country:US
Mailing Address - Phone:956-661-9000
Mailing Address - Fax:956-630-0149
Practice Address - Street 1:15900 LA CANTERA PKWY STE 20115
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-2590
Practice Address - Country:US
Practice Address - Phone:210-354-2020
Practice Address - Fax:956-630-0149
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8759T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist