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1477549764

NPI Code Detail

MEDICARE: DR. JOSEPHINE MANGONI KOSUNICK O.D.

MEDICARE: DR. JOSEPHINE MANGONI KOSUNICK O.D.

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	5326	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000282518	OTHER	OH	ANTHEM BC/BS PROVIDER #
2	000000503349	OTHER	OH	ANTHEM (PARMA)
3	200669	OTHER	OH	CIGNA (DRS KOSUNICK & SC)
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	201924453027	OTHER	OH	CARESOURCE
6	7346559	OTHER	OH	AETNA (WA JONES)
7	000000503347	OTHER	OH	ANTHEM (NORTH OLMSTED)
8	270701075006	OTHER	OH	MEDICAL MUTUAL (PARMA)
9	7346559	OTHER	OH	AETNA
10	R5326	OTHER	OH	SUMMA HEALTH
11	2006698	OTHER	OH	CIGNA HEALTH

General Provider Information

NPI Number	:	1477549764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPHINE MANGONI KOSUNICK O.D.

Provider Business Mailing Address
First Line	:	1261 W ROYALTON RD
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2407
Country	:	US
Telephone Number	:	440-526-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 W ROYALTON RD
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2407
Country	:	US
Telephone Number	:	440-526-7070
Fax Number	:

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	05/17/2023

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Directions to “ DR. JOSEPHINE MANGONI KOSUNICK O.D.” Practice Location

Language	Start Address	Practice Location

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