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General NPI Number Information
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NPI Number | 1497232730
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Entity Type | Individual
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Provider Name | TINA KOSMACH LDO
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Gender | Female
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 7330 EASTGATE RD STE 130
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City | HENDERSON
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State | NV
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Zip | 89011-4048
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Country | US
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Telephone | 702-493-3495
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Fax |
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Provider Business Mailing Address
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Address Line | 7330 EASTGATE RD STE 130
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City | HENDERSON
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State | NV
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Zip | 89011-4048
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Country | US
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Telephone | 702-463-6373
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 456
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License Number State | NV
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