MEDICARE: EDWARD MICHAEL KOSNOSKI

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3410	WA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DF8532	OTHER	WA	RAILROAD MEDICARE GROUP
6	P00446408	OTHER	WA	RAILROAD MEDICARE INDIVIDUAL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	KO7760	OTHER	WA	REGENCE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	0213257	OTHER	WA	LABOR & INDUSTRIES

NPI Number	:	1942200415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD MICHAEL KOSNOSKI

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	04/17/2012