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General NPI Number Information
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NPI Number | 1841833142
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Entity Type | Organization
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Legal Business Name | ELITE VISION CONSULTANTS
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Dates
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Enumeration Date | 10/21/2019
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 123 N MAIN ST STE 102
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City | CROWN POINT
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State | IN
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Zip | 46307-4077
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Country | US
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Telephone | 219-310-2723
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Fax |
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Provider Business Mailing Address
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Address Line | 123 N MAIN ST STE 102
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City | CROWN POINT
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State | IN
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Zip | 46307-4077
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Country | US
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Telephone | 219-310-2723
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. STEPHAN GEORGE KOSSIS
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Credential | OD
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Telephone | 216-789-9066
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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 |
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License Number State |
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