Male or Other

Derek D. Czywczynski O.D.

Optometrist in Hazen, ND(View on Map)

Full Name

Derek David Czywczynski O.D.

NPI Number

1427281583

NPI Type

Individual Provider

Gender

Male

Enumeration Date

08/24/2009

Specialties

(Taxonomies)

Code

152W00000X

Primary Taxonomy

Yes

Licenses

State

Nebraska
North Dakota

License Number

1340
681

Contact
Information

Purpose

Mailing
Location

Address

104 12TH AVE NW
104 12TH AVE NW

City

Hazen
Hazen

State

ND
ND

Postal Code

58545-4100
58545-4100

Country

US
US

Telephone Number

(701) 748-5220
(701) 748-5220

Identifiers

Identifier

60698
893357

Identifier State

ND
ND

Identifier Issuer

Unknown
NORTH DAKOTA VISION SERVICES

Health Information Exchange

Endpoint Type

DIRECT

Endpoint

dczywczynski14578873@direct.sanfordhealth.org

Endpoint Description

Unknown

Use

Unknown

Content Type

Unknown

Affiliation

N

Endpoint Location

506 Beltrami Ave NWBemidji, MN566013010US

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 03/31/2022

Provider Address