Provider Demographics
NPI:1578755757
Name:KOSTELECKY, EVE L (OD)
Entity Type:Individual
Prefix:DR
First Name:EVE
Middle Name:L
Last Name:KOSTELECKY
Suffix:
Gender:F
Credentials:OD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2331 TYLER PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0871
Mailing Address - Country:US
Mailing Address - Phone:701-258-4384
Mailing Address - Fax:701-258-4394
Practice Address - Street 1:2331 TYLER PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0871
Practice Address - Country:US
Practice Address - Phone:701-258-4384
Practice Address - Fax:701-258-4394
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND655152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND713212Medicare PIN