Scott H Kowallis, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

111999-9934 Issued in UT

Practice address

165 W 200 N
71-7
Roosevelt, UT 84066-2834

Phone

(435) 722-2981

Fax

(435) 722-3732

NPI assigned

Sep 14, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 12

Medicare fee-for-service enrollment

Enrolled in UT

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

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Roosevelt Vision Clinic, PC

  • Optometrist
  • Roosevelt, UT
  • NPI 1710973052
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213747200000",
    "number": "1861487050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 W 200 N",
            "address_2": "71-7",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662834",
            "telephone_number": "435-722-2981",
            "fax_number": "435-722-3732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 W 200 N",
            "address_2": "71-7",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662834",
            "telephone_number": "435-722-2981",
            "fax_number": "435-722-3732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALLIS",
        "first_name": "SCOTT",
        "middle_name": "H",
        "name_prefix": "Mr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2008-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "111999-9934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA",
            "identifier": "00437",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107009195101",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MBA",
            "identifier": "123252",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDUCATOR'S MUTUAL",
            "identifier": "870444057K02",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "UT1999",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "12466",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LEGACY NUMBER",
            "identifier": "000009840",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "87041538400001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NTCA",
            "identifier": "87041538400001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTICARE",
            "identifier": "1015",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUCARE",
            "identifier": "87041538400001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VSP",
            "identifier": "870444057",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shalese Marie Killian, FNP-C
• Tammy Killian
• Michiel R. Knight, D.D.S.
• Steven R Knight, CRNA
• Jason Kowallis, OD
• Matthew Robert Kresge, PT, DPT
• Sydnee Kunz
• Brett C Larsen, PA
• Jason Jerry Larson, M.D.
• George Scott Laub

• Optometrist in Roosevelt, UT
• Providers in Roosevelt, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.