Provider Demographics
NPI:1881616712
Name:NOWAKOWSKI, RODNEY (OD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:
Last Name:NOWAKOWSKI
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 1:250 STATE FARM PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7181
Mailing Address - Country:US
Mailing Address - Phone:205-943-4600
Mailing Address - Fax:205-943-4688
Practice Address - Street 1:250 STATE FARM PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-7181
Practice Address - Country:US
Practice Address - Phone:205-943-4600
Practice Address - Fax:205-943-4688
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS362TA069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT69013OtherVIVA HEALTH
AL000059875Medicare PIN
ALT69013Medicare UPIN
0279620004Medicare NSC
LA1586421OtherLOUISIANA MEDICAID
AL410021231OtherRAILROAD MEDICARE
MS07585551OtherMISSISSIPPI MEDICAID
AL636005396OtherVISION SERVICES PLAN
AL51059875OtherBCBS
AL000059875Medicaid