Provider Demographics
NPI:1104379452
Name:KOWALSKI, CHRISTOPHER (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 S CENTER RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1700
Mailing Address - Country:US
Mailing Address - Phone:810-744-1950
Mailing Address - Fax:
Practice Address - Street 1:1235 S CENTER RD
Practice Address - Street 2:SUITE 16
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1700
Practice Address - Country:US
Practice Address - Phone:810-744-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist