Provider Demographics
NPI:1457400517
Name:KOWALIK, RONALD S (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:S
Last Name:KOWALIK
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 1:57 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-3203
Mailing Address - Country:US
Mailing Address - Phone:973-340-0489
Mailing Address - Fax:
Practice Address - Street 1:57 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-3203
Practice Address - Country:US
Practice Address - Phone:973-340-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00299001152W00000X
NJK0521338152W00000X
NJ1608002152W00000X
NJUPN U26870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist