Provider Demographics
NPI:1801834080
Name:KOSEK, LEON J (OD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:J
Last Name:KOSEK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21237 S LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2046
Mailing Address - Country:US
Mailing Address - Phone:815-469-8541
Mailing Address - Fax:815-469-8126
Practice Address - Street 1:21237 S LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2046
Practice Address - Country:US
Practice Address - Phone:815-469-8541
Practice Address - Fax:815-469-8126
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001974A152W00000X
IL046007472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100086900AMedicaid
IL0218400001Medicare NSC
IN100086900AMedicaid
IL948760Medicare PIN