Provider Demographics
NPI:1811532302
Name:KAWA, KATARZYNA KRYSTYNA (OD)
Entity type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:KRYSTYNA
Last Name:KAWA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATARZYNA
Other - Middle Name:K
Other - Last Name:DUDZIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:70 E 68TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3506
Mailing Address - Country:US
Mailing Address - Phone:219-736-2020
Mailing Address - Fax:219-769-3884
Practice Address - Street 1:1861 E SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2768
Practice Address - Country:US
Practice Address - Phone:219-663-4450
Practice Address - Fax:219-663-4455
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004205A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18004205AOtherLICENSE
IN18004205BOtherOPTOMETRIC LEGEND DRUG