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NPI Code Detail

MEDICARE: EDWARD HENRY KOSNOSKI O.D.

MEDICARE:   EDWARD HENRY KOSNOSKI  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist0879WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1K00125OTHERWAREGENCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
326984OTHERWALABOR & INDUSTRIES

General Provider Information

NPI Number : 1891794509
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD HENRY KOSNOSKI O.D.
Provider Business Mailing Address
First Line : PO BOX 6609
Second Line :
City : KENT
State : WA
Zip : 98064-6609
Country : US
Telephone Number : 253-852-2020
Fax Number : 253-854-2020
Provider Business Practice Location Address
First Line : 10002 SE 240TH ST
Second Line :
City : KENT
State : WA
Zip : 98031-4839
Country : US
Telephone Number : 253-852-2020
Fax Number : 253-854-2020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 07/08/2007

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Directions to “ EDWARD HENRY KOSNOSKI O.D.” Practice Location

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