Provider Demographics
NPI:1215921564
Name:KOKOSKA, MIKEL M (OD)
Entity type:Individual
Prefix:DR
First Name:MIKEL
Middle Name:M
Last Name:KOKOSKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:M
Other - Last Name:KOKOSKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:16111 COPELAND FARMS ROAD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556
Mailing Address - Country:US
Mailing Address - Phone:813-817-6547
Mailing Address - Fax:
Practice Address - Street 1:8102 CITRUS PARK TOWN CENTER
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625
Practice Address - Country:US
Practice Address - Phone:813-926-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084741100Medicaid
FL180016475OtherRR MEDICARE
FL931211OtherHUMANA VCP
FL13062OtherHERITAGE
FL18630OtherSPECTERA
FL22871OtherUNITED HEALTH GROUP VISION PLANS
FL931211OtherEYEMED