MEDICARE: DR. CHRISTOPHER J. NOWIK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG-000536	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4508644	OTHER	PA	AETNA
2	NO1593770	OTHER	PA	HIGHMARK BLUE SHIELD
3	01405801	OTHER	PA	CAPITAL BLUE CROSS
4	5029340001	OTHER	PA	DMERC A
5	P00097101	OTHER	PA	PALMETTO GBA RAILROAD

General Provider Information

NPI Number	:	1114926938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER J. NOWIK O.D.

Provider Business Mailing Address
First Line	:	385 BANGOR JUNCTION RD
Second Line	:
City	:	BANGOR
State	:	PA
Zip	:	18013-9369
Country	:	US
Telephone Number	:	610-588-0129
Fax Number	:	610-588-4700

Provider Business Practice Location Address
First Line	:	385 BANGOR JUNCTION RD
Second Line	:
City	:	BANGOR
State	:	PA
Zip	:	18013-9369
Country	:	US
Telephone Number	:	610-588-0129
Fax Number	:	610-588-4700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	10/20/2022

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