Provider Demographics
NPI:1518003789
Name:KOKOSKY, GARY JON (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JON
Last Name:KOKOSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 GLASE RD
Mailing Address - Street 2:
Mailing Address - City:DANIELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18038-9692
Mailing Address - Country:US
Mailing Address - Phone:610-837-2394
Mailing Address - Fax:
Practice Address - Street 1:147 PALMER PARK MALL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2759
Practice Address - Country:US
Practice Address - Phone:610-258-4372
Practice Address - Fax:610-258-5878
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA887976OtherBLUE SHIELD
PA50023492OtherCAPITAL BC
PAMA887976OtherBLUE SHIELD
PAU84263Medicare UPIN
PA50023492OtherCAPITAL BC