Individual
THOMAS R CZYZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
42201 N 41ST DR, SUITE 124-128, ANTHEM, AZ 85086-3800
(623) 551-9122
(623) 551-9120
Mailing address
42201 N 41ST DR, SUITE 144, ANTHEM, AZ 85086-3800
(623) 551-9122
(623) 551-9120
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1146
AZ
152WC0802X
Corneal and Contact Management Optometrist
1146
AZ
152WL0500X
Low Vision Rehabilitation Optometrist
1146
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0903340
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
08/30/2006
Last updated
01/17/2014
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