MEDICARE: KOSNOSKI EYE CARE INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152WC0802X	Corneal and Contact Management Optometrist
2	152WL0500X	Low Vision Rehabilitation Optometrist
3	152WX0102X	Occupational Vision Optometrist
4	152WP0200X	Pediatric Optometrist
5	152WS0006X	Sports Vision Optometrist
6	152WV0400X	Vision Therapy Optometrist
7	152W00000X	Optometrist

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF8532	OTHER	WA	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1003995747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOSNOSKI EYE CARE INC

Provider Business Mailing Address
First Line	:	10002 SE 240TH ST
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-4839
Country	:	US
Telephone Number	:	253-852-2020
Fax Number	:	253-854-2020

Provider Business Practice Location Address
First Line	:	10002 SE 240TH ST
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-4839
Country	:	US
Telephone Number	:	253-852-2020
Fax Number	:	253-854-2020

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD M KOSNOSKI
Credential	:	O.D.
Telephone Number	:	253-852-2020

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	04/17/2012