Provider Demographics
NPI:1376820795
Name:PHILIP H. NOWAK, O.D., P.C.
Entity Type:Organization
Organization Name:PHILIP H. NOWAK, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:800-353-5420
Mailing Address - Street 1:PO BOX 1721
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-0721
Mailing Address - Country:US
Mailing Address - Phone:800-353-5420
Mailing Address - Fax:812-331-8049
Practice Address - Street 1:410 GRAND VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-6123
Practice Address - Country:US
Practice Address - Phone:800-353-5420
Practice Address - Fax:812-331-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002922152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty