Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 27OA00558400 | NJ |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 27OA00558400 | NJ |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 27OA00558400 | NJ |
N | 152WP0200X | Pediatric Optomitrist | 27OA00558400 | NJ |
N | 152WS0006X | Sports Vision | 27OA00558400 | NJ |
N | 152WV0400X | Optomitrist - Vision Therapist | 27OA00558400 | NJ |
NPI | 1194892455 |
---|---|
Provider Name | Dr. Paul Kossis |
First Address | Haddon Heights, NJ 08035-1909 |
Second Address | Haddon Heights, NJ 08035-1909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7849303 | (05) | NJ |
U65010 | (02) | NJ |