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General NPI Number Information
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NPI Number | 1326218215
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Entity Type | Organization
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Legal Business Name | TAD R KOSANOVICH OD PA
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 150 S INDIANA AVE
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City | ENGLEWOOD
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State | FL
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Zip | 34223-3307
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Country | US
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Telephone | 941-473-1392
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Fax | 941-473-9379
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Provider Business Mailing Address
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Address Line | 150 S INDIANA AVE
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City | ENGLEWOOD
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State | FL
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Zip | 34223-3307
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Country | US
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Telephone | 941-473-1392
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Fax | 941-473-9379
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAD R KOSANOVICH
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Credential | OD
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Telephone | 941-473-1392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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