Organization
ELITE VISION CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHAN GEORGE KOSSIS OD (OWNER/OPTOMETRIST)
(216) 789-9066
Entity
Organization
Contact information
Practice address
123 N MAIN ST STE 102, CROWN POINT, IN 46307-4077
(219) 310-2723
Mailing address
123 N MAIN ST STE 102, CROWN POINT, IN 46307-4077
(219) 310-2723
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962859512
PROVIDER NPI
—
05
—
210361680
—
IN
Enumeration date
10/21/2019
Last updated
10/21/2019
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