Provider Demographics
NPI:1679743850
Name:KOSKO EYE CLINIC, PA
Entity Type:Organization
Organization Name:KOSKO EYE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:IGOR
Authorized Official - Last Name:KOSKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-453-1133
Mailing Address - Street 1:1503 STRONG AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-4036
Mailing Address - Country:US
Mailing Address - Phone:662-453-1133
Mailing Address - Fax:662-455-9109
Practice Address - Street 1:1503 STRONG AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4036
Practice Address - Country:US
Practice Address - Phone:662-453-1133
Practice Address - Fax:662-455-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7328332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0310590001Medicare NSC
MSB31141Medicare UPIN