Individual
DR. MARK EDWARD KOSCIUSZKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
50 W CARLETON RD, HILLSDALE, MI 49242-1202
(517) 439-2020
(517) 437-5577
Mailing address
50 W CARLETON RD, HILLSDALE, MI 49242-1202
(517) 439-2020
(517) 437-5577
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002884
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2230027
IBA PHP
MI
01
—
37252313
VSP
MI
01
—
4414910001
DMERC
MI
05
—
4696989
—
MI
01
—
900A210280
BCBSM
MI
Enumeration date
10/13/2005
Last updated
04/08/2015
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