Healthcare Provider Details

I. General information

NPI: 1114926938
Provider Name (Legal Business Name): CHRISTOPHER J. NOWIK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 BANGOR JUNCTION RD
BANGOR PA
18013-9369
US

IV. Provider business mailing address

385 BANGOR JUNCTION RD
BANGOR PA
18013-9369
US

V. Phone/Fax

Practice location:
  • Phone: 610-588-0129
  • Fax: 610-588-4700
Mailing address:
  • Phone: 610-588-0129
  • Fax: 610-588-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG-000536
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: