Individual
JASON KOWALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
165 W 200 N, ROOSEVELT, UT 84066-2834
(435) 722-5890
Mailing address
165 W 200 N, ROOSEVELT, UT 84066-2834
(435) 722-5890
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
8288486
UT
152WV0400X
Vision Therapy Optometrist
8288486
UT
Other
Enumeration date
06/01/2012
Last updated
02/02/2017
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