Provider Demographics
NPI:1659549269
Name:GREGORY J & RONALD J NOWAK PTRS
Entity Type:Organization
Organization Name:GREGORY J & RONALD J NOWAK PTRS
Other - Org Name:TWINSITE OPTICAL COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:586-773-8260
Mailing Address - Street 1:13734 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3751
Mailing Address - Country:US
Mailing Address - Phone:586-773-8260
Mailing Address - Fax:586-773-7940
Practice Address - Street 1:13734 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3751
Practice Address - Country:US
Practice Address - Phone:586-773-8260
Practice Address - Fax:586-773-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E00825OtherBCBS
MI540E00825OtherBCBS