Individual
DR. CORY J. BOSANKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
39 LANTANA RD, CROSSVILLE, TN 38555-4901
(931) 484-3344
(931) 456-3671
Mailing address
39 LANTANA RD, CROSSVILLE, TN 38555-4901
(931) 484-3344
(931) 456-3671
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OD2541
TN
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
OD0000002541
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3943261
—
TN
05
—
3946606
—
TN
01
—
4109506
BCBST
TN
Enumeration date
08/02/2005
Last updated
01/22/2021
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