Provider Demographics
NPI:1609971837
Name:KOSIR FAMILY EYECARE, PLLC
Entity Type:Organization
Organization Name:KOSIR FAMILY EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:KOSIR
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:701-293-6716
Mailing Address - Street 1:4204 38TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-293-6716
Mailing Address - Fax:
Practice Address - Street 1:4204 38TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7549
Practice Address - Country:US
Practice Address - Phone:701-293-6716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty