Provider Demographics
NPI:1881774974
Name:KOSNOSKI EYE CARE INC
Entity type:Organization
Organization Name:KOSNOSKI EYE CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOSNOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-852-2020
Mailing Address - Street 1:10002 SE 240TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-4839
Mailing Address - Country:US
Mailing Address - Phone:253-852-2020
Mailing Address - Fax:253-854-2020
Practice Address - Street 1:10002 SE 240TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-4839
Practice Address - Country:US
Practice Address - Phone:253-852-2020
Practice Address - Fax:253-854-2020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOSNOSKI EYE CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1021416Medicaid
WADF8532OtherRAILROAD MEDICARE
WA1021416Medicaid