Healthcare Provider Details

I. General information

NPI: 1811221518
Provider Name (Legal Business Name): ALLYSON MARIE KOWALESKI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSON MARIE SEILER OD

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 BRICE RD
REYNOLDSBURG OH
43068-2705
US

IV. Provider business mailing address

1014 S FRONT ST
COLUMBUS OH
43206-2559
US

V. Phone/Fax

Practice location:
  • Phone: 614-861-7771
  • Fax: 614-219-7350
Mailing address:
  • Phone: 614-861-7771
  • Fax: 614-219-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5978
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: