Provider Demographics
NPI:1871229864
Name:WADOWSKA, MARIA MAGDALENA (OD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MAGDALENA
Last Name:WADOWSKA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 BELLINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3059
Mailing Address - Country:US
Mailing Address - Phone:908-307-4887
Mailing Address - Fax:
Practice Address - Street 1:706 SW PINE ISLAND RD UNIT 102
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2053
Practice Address - Country:US
Practice Address - Phone:407-774-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00182000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist