Individual
MR. SCOTT H KOWALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
165 W 200 N, 71-7, ROOSEVELT, UT 84066-2834
(435) 722-2981
(435) 722-3732
Mailing address
165 W 200 N, 71-7, ROOSEVELT, UT 84066-2834
(435) 722-2981
(435) 722-3732
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
111999-9934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000009840
MEDICARE LEGACY NUMBER
UT
01
—
00437
VA
—
01
—
1015
OPTICARE
UT
01
—
107009195101
IHC
—
01
—
123252
MBA
—
01
—
12466
PEHP
—
01
—
87041538400001
BCBS
UT
01
—
87041538400001
NTCA
—
01
—
870444057
VSP
—
01
—
870444057K02
EDUCATOR'S MUTUAL
—
01
—
UT1999
EYEMED
—
Enumeration date
09/14/2005
Last updated
06/18/2008
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