Healthcare Provider Details

I. General information

NPI: 1245371483
Provider Name (Legal Business Name): LISA MARIA KOWAR OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E MAIN ST
BARRINGTON IL
60010
US

IV. Provider business mailing address

330 E MAIN ST
BARRINGTON IL
60010-3203
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-5313
  • Fax: 847-381-5468
Mailing address:
  • Phone: 847-381-5313
  • Fax: 847-381-5468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-008020
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: