MEDICARE: ZACKARY KOSISKY OD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT002725	AZ

General Provider Information

NPI Number	:	1184305278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACKARY KOSISKY OD

Provider Business Mailing Address
First Line	:	3120 E UNION HILLS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3421
Country	:	US
Telephone Number	:	602-867-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 E UNION HILLS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3421
Country	:	US
Telephone Number	:	602-867-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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Directions to “ ZACKARY KOSISKY OD” Practice Location

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