NPIMap

Organization Active NPI

Kosnoski Eye Care Inc

  • Optometrist
  • Kent, WA
National Provider Identifier
1003995747
Registry record updated Apr 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
KOSNOSKI EYE CARE INC
Practice address
10002 SE 240TH St
Kent, WA 98031-4839
Phone
(253) 852-2020
Fax
(253) 854-2020
NPI assigned
Nov 3, 2006
Last updated
Apr 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Edward M Kosnoski, O.D.NPI 1942200415
Title
Owner
Phone
(253) 852-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary
Corneal and Contact Management Optometrist 152WC0802X NU
Low Vision Rehabilitation Optometrist 152WL0500X NU
Pediatric Optometrist 152WP0200X NU
Sports Vision Optometrist 152WS0006X NU
Vision Therapy Optometrist 152WV0400X NU
Occupational Vision Optometrist 152WX0102X NU

Addresses

Primary practice location

10002 SE 240TH St
Kent, WA 98031-4839

Mailing address

10002 SE 240TH St
Kent, WA 98031-4839
Phone (253) 852-2020

Other identifiers 4

IdentifierTypeStateIssuer
1012250MedicaidWA
1021416MedicaidWA
DF8532OtherWARAILROAD MEDICARE
1006117MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070130000741 WA Part B Supplier - Clinic/Group Practice 7618978859 Receives reassigned benefits from 12 practitioners
3 other NPIs on this enrollment
Practice locations: Auburn, WA; Renton, WA; Puyallup, WA; Federal Way, WA; Kent, WA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Kosnoski Eye Care Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10002 SE 240th St
Kent, WA 98031
Phone (253) 852-2020

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334620800000",
    "number": "1003995747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10002 SE 240TH ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980314839",
            "telephone_number": "253-852-2020",
            "fax_number": "253-854-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10002 SE 240TH ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980314839",
            "telephone_number": "253-852-2020",
            "fax_number": "253-854-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOSNOSKI EYE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2012-04-17",
        "status": "A",
        "authorized_official_last_name": "KOSNOSKI",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-852-2020",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012250",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021416",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF8532",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1006117",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.