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Individual

STUART A KOSIKOWSKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
421 CAMELOT DR, FOND DU LAC, WI 54935-4560
(920) 926-8472
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8472

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2012
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12565
DEAN
WI
05
38525900
WI
01
39080723646
UNITY
WI
01
410029533
RAILROAD MEDICARE
WI
01
501574
TOUCHPOINT
WV
01
WI01J4
JOHN DEERE
WI
Enumeration date
11/14/2005
Last updated
11/18/2020
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