Provider Demographics
NPI:1740319441
Name:NOWAK, RICHARD JOSEPH (OD MS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:NOWAK
Suffix:
Gender:M
Credentials:OD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 NORTH ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088
Mailing Address - Country:US
Mailing Address - Phone:860-623-8217
Mailing Address - Fax:860-627-7706
Practice Address - Street 1:155 NORTH ROAD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088
Practice Address - Country:US
Practice Address - Phone:860-623-8217
Practice Address - Fax:860-627-7706
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
398175OtherUHC
CT603005OtherCONN CARE
CT090000725CT01OtherBLUE CROSS
CT004023883Medicaid
CT004023883Medicaid
T23347Medicare UPIN