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General NPI Number Information
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NPI Number | 1528145257
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Entity Type | Individual
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Provider Name | GERALD W. KOSS II O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/08/2014
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Provider Practice Location Address
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Address Line | 90 VILLAGE AT GLYNN PL
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City | BRUNSWICK
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State | GA
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Zip | 31525-1993
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Country | US
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Telephone | 912-264-6000
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Fax | 912-264-6080
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Provider Business Mailing Address
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Address Line | 90 VILLAGE AT GLYNN PL
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City | BRUNSWICK
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State | GA
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Zip | 31525-1993
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Country | US
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Telephone | 912-264-6000
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Fax | 912-264-6080
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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 | 2249
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002249
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4033
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License Number State | FL
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