Jason Kowallis, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

8288486 Issued in UT

Practice address

165 W 200 N
Roosevelt, UT 84066-2834

Phone

(435) 722-5890

NPI assigned

Jun 1, 2012

Last updated

Feb 2, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Optometry

Education

Southern College of Optometry, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Roosevelt Vision Clinic PCGroup PAC ID 9830269844, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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

• Roosevelt Vision Clinic, PC

  • Optometrist
  • Roosevelt, UT
  • NPI 1710973052
  Medicare reassignment Care Compare group NPD
• Retina and Vitreous Surgeons of Utah, LLC

  • Retina Specialist (Ophthalmology) Physician
  • Provo, UT
  • NPI 1518117407
  NPD (past)

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

{
    "created_epoch": "1338508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485993600000",
    "number": "1942561311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 W 200 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662834",
            "telephone_number": "435-722-5890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 W 200 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662834",
            "telephone_number": "435-722-5890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALLIS",
        "first_name": "JASON",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-01",
        "last_updated": "2017-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "8288486",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "UT",
            "license": "8288486",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• 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 Feb 2, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.