Provider Demographics
NPI:1770674046
Name:KOS, TERESA (OD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:KOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:KOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:250 NORTHAMPTON STREET
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1046
Mailing Address - Country:US
Mailing Address - Phone:413-527-9284
Mailing Address - Fax:413-527-8181
Practice Address - Street 1:250 NORTHAMPTON STREET
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1046
Practice Address - Country:US
Practice Address - Phone:413-527-9284
Practice Address - Fax:413-527-8181
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3098152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
042797983OtherVSP
103098OtherTUFTS
13664OtherHNE
W15608OtherBCBS
MA0350664Medicaid
W15608OtherBCBS