=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518047620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOSNOSKI EYE CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 05/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14270 SE 176TH ST
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98058-8787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-255-6860
-----------------------------------------------------
Fax | 425-255-3262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10002 SE 240TH ST
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98031-4839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-852-2020
-----------------------------------------------------
Fax | 253-854-2020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EDWARD M KOSNOSKI
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 253-852-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------