Healthcare Provider Details

I. General information

NPI: 1538127550
Provider Name (Legal Business Name): GREGORY JOSEPH KOVATS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26927 DETROIT RD
WESTLAKE OH
44145-2370
US

IV. Provider business mailing address

26927 DETROIT RD
WESTLAKE OH
44145-2370
US

V. Phone/Fax

Practice location:
  • Phone: 440-892-5367
  • Fax: 440-249-5094
Mailing address:
  • Phone: 440-892-5367
  • Fax: 440-249-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5485 T2397
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: