Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | OS60918580 | WA |
NPI | 1144882556 |
---|---|
Provider Name | Brian E Koceski |
First Address | Seattle, WA 98125-7471 |
Second Address | Seattle, WA 98125-7471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2019 |
Last Update Date | 05/07/2019 |