Organization
HAZEN FAMILY EYECARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK DAVID CZYWCZYNSKI O.D. (OWNER/OPTOMETRIST)
(701) 516-2115
Entity
Organization
Contact information
Practice address
104 12TH AVE NW, SUITE #1, HAZEN, ND 58545-4100
(701) 748-5220
(701) 748-5221
Mailing address
104 12TH AVE NW, SUITE #1, HAZEN, ND 58545-4100
(701) 748-5220
(701) 748-5221
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
681
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12122586
CAQH
ND
01
—
1427281583
OPTOMETRIST NPI
ND
05
—
60698
—
ND
01
—
681
STATE LICENSE NUMBER
ND
Enumeration date
04/18/2014
Last updated
03/07/2023
Update your record
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