MEDICARE: DR. RONALD S KOWALIK OD

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	27OA00299001	NJ
2	152W00000X	Optometrist	K0521338	NJ
3	152W00000X	Optometrist	1608002	NJ
4	152W00000X	Optometrist	UPN U26870	NJ

General Provider Information

NPI Number	:	1457400517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD S KOWALIK OD

Provider Business Mailing Address
First Line	:	57 BELMONT AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-3203
Country	:	US
Telephone Number	:	973-340-0489
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 BELMONT AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-3203
Country	:	US
Telephone Number	:	973-340-0489
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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