Provider Demographics
NPI:1992254635
Name:KOSNOSKI EYE CARE, INC
Entity type:Organization
Organization Name:KOSNOSKI EYE CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOSNOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-852-2020
Mailing Address - Street 1:10002 SE 240TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-4839
Mailing Address - Country:US
Mailing Address - Phone:253-852-2020
Mailing Address - Fax:253-854-2020
Practice Address - Street 1:2314 SW 336TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2848
Practice Address - Country:US
Practice Address - Phone:253-874-8125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty