Healthcare Provider Details

I. General information

NPI: 1811532302
Provider Name (Legal Business Name): KATARZYNA KRYSTYNA KAWA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATARZYNA K DUDZIK OD

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 E SUMMIT ST
CROWN POINT IN
46307-2768
US

IV. Provider business mailing address

70 E 68TH PL
MERRILLVILLE IN
46410-3506
US

V. Phone/Fax

Practice location:
  • Phone: 219-663-4450
  • Fax: 219-663-4455
Mailing address:
  • Phone: 219-736-2020
  • Fax: 219-769-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004205A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: