Provider Demographics
NPI:1801883947
Name:NOWAKOWSKI, KARON KLEM (OD)
Entity type:Individual
Prefix:
First Name:KARON
Middle Name:KLEM
Last Name:NOWAKOWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 W BETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5510
Mailing Address - Country:US
Mailing Address - Phone:765-288-7744
Mailing Address - Fax:765-282-0741
Practice Address - Street 1:4801 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5510
Practice Address - Country:US
Practice Address - Phone:765-288-7744
Practice Address - Fax:765-282-0741
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002429152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0240890001OtherDMERC
IN208050Medicare PIN
0240890001OtherDMERC