Provider Demographics
NPI:1295718179
Name:CSONKA, NATHAN WILLIAM (OD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:WILLIAM
Last Name:CSONKA
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 1:1801 BUTLER PIKE
Mailing Address - Street 2:APT 97
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-3156
Mailing Address - Country:US
Mailing Address - Phone:215-380-2697
Mailing Address - Fax:215-674-4323
Practice Address - Street 1:179 YORK RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4514
Practice Address - Country:US
Practice Address - Phone:215-674-2020
Practice Address - Fax:215-674-4323
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA095851VP1Medicare PIN
PAV07211Medicare UPIN