Provider Demographics
NPI:1497232730
Name:KOSMACH, TINA (LDO)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:KOSMACH
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 EASTGATE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-4048
Mailing Address - Country:US
Mailing Address - Phone:702-463-6373
Mailing Address - Fax:
Practice Address - Street 1:7330 EASTGATE RD STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4048
Practice Address - Country:US
Practice Address - Phone:702-493-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV456156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician