Individual provider Active NPI

Richard M. Kowalski, O.D.

  • Optometrist
  • Lebanon, PA
National Provider Identifier
1720058480
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG000119 Issued in PA
Practice address
875 Norman Dr
Lebanon, PA 17042-7454
Phone
(717) 272-2010
Fax
(717) 272-2937
NPI assigned
Jan 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG000119 PA Primary

Addresses

Primary practice location

875 Norman Dr
Lebanon, PA 17042-7454

Mailing address

111 Trillium Dr
Palmyra, PA 17078-9006
Phone (717) 657-2020

Other identifiers 1

IdentifierTypeStateIssuer
0017250110001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111212000696 PA Practitioner - Optometry 1153534169 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
George E. Fava MD PCGroup PAC ID 7517942428, 7 clinicians

Practice addresses (Care Compare)

4407 Carlisle Pike
Suite D
Camp Hill, PA 17011-4159
Phone (717) 975-2015

875 Norman Dr
Lebanon, PA 17042-7454
Phone (717) 275-2010

Merit-based Incentive Payment System (MIPS)

Final score
85.08 of 100Reported as group
Quality
85.29
Promoting interoperability
100
Improvement activities
40
Cost
64.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG000119PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Vision Innovation Centers of Pennsylvania LLC Optometrist CurrentSince Dec 22, 2021 Accepting new patients
George E. Fava MD PC CurrentSince Feb 16, 2026 Accepting new patients
Vision Innovation Centers of Pennsylvania LLC Optometrist CurrentSince Dec 22, 2021 Accepting new patients
George E Fava MD PC Optometrist CurrentSince Feb 16, 2026 Accepting new patients
Vision Innovation Centers of Pennsylvania LLC Optometrist Current Accepting new patients
Vision Innovation Centers of Pennsylvania LLC Optometrist Past Accepting new patients
Lebanon Eyecare Associates Optometrist Past Accepting new patients

Locations

2661 Riva Rd
Ste 1030
Annapolis, MD 21401

4407 Carlisle Pike
Camp Hill, PA 17011
Phone 7179752015 ext. 52015

4407 Carlisle Pike
Ste D
Camp Hill, PA 17011
Phone (717) 975-2015

703 Rutter Ave
Kingston, PA 18704
Phone (570) 288-7405

875 Norman Dr
Lebanon, PA 17042
Phone (717) 272-2010

4100 Linglestown Rd
Linglestown, PA 17112
Phone (717) 657-2020

170 Boston Ave
West Pittston, PA 18643
Phone (570) 602-1010

1880 Kenneth Rd
Ste 1
York, PA 17408
Phone (717) 767-2000

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1720058480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 TRILLIUM DR",
            "city": "PALMYRA",
            "state": "PA",
            "postal_code": "170789006",
            "telephone_number": "717-657-2020",
            "fax_number": "717-272-2937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 NORMAN DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427454",
            "telephone_number": "717-272-2010",
            "fax_number": "717-272-2937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALSKI",
        "first_name": "RICHARD",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2026-07-13",
        "certification_date": "2026-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017250110001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.