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General NPI Number Information
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NPI Number | 1558139113
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Entity Type | Individual
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Provider Name | JOSEPH ANTHONY KOKE
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Gender | Male
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 6819 WALTONS LN
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City | GLOUCESTER
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State | VA
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Zip | 23061-6113
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Country | US
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Telephone | 804-693-2623
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Fax | 804-693-8905
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Provider Business Mailing Address
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Address Line | 6400 MAIN ST
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City | GLOUCESTER
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State | VA
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Zip | 23061-5511
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Country | US
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Telephone | 757-708-1294
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1101003962
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License Number State | VA
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