Healthcare Provider Details

I. General information

NPI: 1982632188
Provider Name (Legal Business Name): MACIEJ ZBIGNIEW KOWALSKI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26672 MARGARITA RD. SUITE 305
MURRIETA CA
92563
US

IV. Provider business mailing address

28656 BAR HARBOR LN
TEMECULA CA
92591-2520
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-1515
  • Fax:
Mailing address:
  • Phone: 951-551-6531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12596T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: