Healthcare Provider Details

I. General information

NPI: 1245215748
Provider Name (Legal Business Name): JOHN BOKOSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 11/09/2025
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 3RD AVE
SAN DIEGO CA
92103-3002
US

IV. Provider business mailing address

3939 3RD AVE
SAN DIEGO CA
92103-3002
US

V. Phone/Fax

Practice location:
  • Phone: 619-296-8525
  • Fax: 619-692-0229
Mailing address:
  • Phone: 619-296-8525
  • Fax: 619-692-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG51651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: