Paul Victor Kowalski, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

036079360 Issued in IL

Practice address

2000 W Morton Ave
Jacksonville, IL 62650-2623

Phone

(217) 245-6814

Fax

(217) 245-0375

NPI assigned

Jun 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Hecker Ophthalmology PA

  • Ophthalmology Physician
  • Greensboro, NC
  • NPI 1447319454
  NPD
• Lahaye Total Eye Care of Lake Charles, Inc

  • Clinic/Center
  • Lake Charles, LA
  • NPI 1497742613
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692

  Ophthalmology

  NPD (past)
• Southeastern Cataract Laser Center

  • Ophthalmology Physician
  • Greensboro, NC
  • NPI 1063771616
  NPD (past)
• Tri-State Centers for Sight Inc

  • Ophthalmology Physician
  • Danville, KY
  • NPI 1801719869
  NPD (past)

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

{
    "created_epoch": "1117670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454457600000",
    "number": "1740282797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 W ILES AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047015",
            "telephone_number": "217-698-3030",
            "fax_number": "217-698-3068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 W MORTON AVE",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626502623",
            "telephone_number": "217-245-6814",
            "fax_number": "217-245-0375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALSKI",
        "first_name": "PAUL",
        "middle_name": "VICTOR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-02",
        "last_updated": "2016-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "GA",
            "license": "053472",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NC",
            "license": "200301373",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036079360",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "336042367",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROV #",
            "identifier": "141F1",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTICARE PROVIDER NUMBER",
            "identifier": "33079",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PROV. NUMBER",
            "identifier": "P00395184",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902639",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS PROV NUMBER",
            "identifier": "807073",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Ketcham, PHARMD
• Michael W. King, P.A.-C.
• Carl L Klemaier, LCPC
• Michael Knous, RBT
• Matt Koster
• Robert A Krueger, D.D.S., M.S.D.
• Annette Kutz Schippel, D.C.
• Jessica Landon
• Jamie Lee Landsverk, FNP-BC
• Bryan M Langan, ATC

• Ophthalmology Physician in Jacksonville, IL
• Providers in Jacksonville, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.