Provider Demographics
NPI:1548419948
Name:KOKOTOW, NATALIE (OD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:KOKOTOW
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 1:343 BRANTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4307
Mailing Address - Country:US
Mailing Address - Phone:716-512-5830
Mailing Address - Fax:
Practice Address - Street 1:5467 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6701
Practice Address - Country:US
Practice Address - Phone:716-632-7944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12514152W00000X
NY7258152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist