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Organization

EDWARD P. KOSANKE, OPTOMETRIST P.C

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. EDWARD PAUL KOSANKE O.D. (PRESIDENT)
(231) 627-5666
Entity
Organization

Contact information

Practice address
730 S MAIN ST, CHEBOYGAN, MI 49721-2220
(231) 627-5666
Mailing address
730 S MAIN ST, CHEBOYGAN, MI 49721-2220
(231) 627-5666

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002498
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
945103234
MI
Enumeration date
08/13/2007
Last updated
09/10/2010
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