Healthcare Provider Details

I. General information

NPI: 1144882556
Provider Name (Legal Business Name): BRIAN E KOCESKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10212 5TH AVE NE STE 210
SEATTLE WA
98125-7471
US

IV. Provider business mailing address

10212 5TH AVE NE STE 210
SEATTLE WA
98125-7471
US

V. Phone/Fax

Practice location:
  • Phone: 206-522-4222
  • Fax: 206-525-1496
Mailing address:
  • Phone: 206-522-4222
  • Fax: 206-525-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License NumberOS60918580
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: