Provider Demographics
NPI:1689855892
Name:KOSTOGIANNIS, FOTINI (OD)
Entity Type:Individual
Prefix:DR
First Name:FOTINI
Middle Name:
Last Name:KOSTOGIANNIS
Suffix:
Gender:F
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:MASS OPTOMETRIC ASSOCIATES, P.C.
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-446-3145
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:1623 BEACON ST
Practice Address - Street 2:MASS OPTOMETRIC ASSOCIATES, P.C.
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4531
Practice Address - Country:US
Practice Address - Phone:617-739-2707
Practice Address - Fax:617-730-4418
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist