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General NPI Number Information
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NPI Number | 1275119661
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Entity Type | Individual
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Provider Name | EVAN KELTON DACKOWSKI MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 3100 WESLAYAN ST STE 400
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City | HOUSTON
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State | TX
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Zip | 77027-5752
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Country | US
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Telephone | 713-526-1600
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Fax | 713-526-0679
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Provider Business Mailing Address
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Address Line | 21502 MERCHANTS WAY
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City | KATY
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State | TX
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Zip | 77449-2517
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Country | US
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Telephone | 281-944-2232
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Fax | 281-944-2290
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 125.078712
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | V7489
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License Number State | TX
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