Healthcare Provider Details

I. General information

NPI: 1326099789
Provider Name (Legal Business Name): WILLIAM CLAYTON COSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ERIE ST S
MEDINA NY
14103-1010
US

IV. Provider business mailing address

500 ERIE ST
MEDINA NY
14103-1010
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-2020
  • Fax: 585-798-3365
Mailing address:
  • Phone: 585-798-2020
  • Fax: 585-798-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2393991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: