| Doctor Name: | RONALD JOSEPH NOWAK |
| NPI Number: | 1013053586 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 13734 E 12 Mile Rd Warren, MI - 480883751 |
| Business Phone Number: | 5867738260 |
| Business Fax Number: | 5867737940 |
| Mailing Address: | 13734 E 12 Mile Rd, WARREN |
| State: | MI |
| Postal Code: | 480883751 |
| Phone Number: | 5867738260 |
| Fax Number: | 5867737940 |
| NPI Enumeration Date: | 01/30/2007 |
| NPI Last Update Date: | 01/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |