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General NPI Number Information
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NPI Number | 1215921564
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Entity Type | Individual
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Provider Name | MIKEL M KOKOSKA O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2005
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 8102 CITRUS PARK TOWN CENTER
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City | TAMPA
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State | FL
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Zip | 33625
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Country | US
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Telephone | 813-926-6288
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Fax |
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Provider Business Mailing Address
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Address Line | 16111 COPELAND FARMS ROAD
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City | ODESSA
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State | FL
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Zip | 33556
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Country | US
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Telephone | 813-817-6547
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC2472
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License Number State | FL
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