Individual
KEITH EDWARD KOWALSKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3100 N DRIES LN, SUITE 101, PEORIA, IL 61604-1259
(309) 688-6644
(309) 688-6670
Mailing address
3100 N DRIES LN, SUITE 101, PEORIA, IL 61604-1259
(309) 688-6644
(309) 688-6670
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0918690001
DMERC
IL
Enumeration date
09/25/2006
Last updated
07/09/2007
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