Provider Demographics
NPI:1043612435
Name:KRUSZEWSKI OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:KRUSZEWSKI OPTOMETRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRUSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-243-0370
Mailing Address - Street 1:15175 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-5038
Mailing Address - Country:US
Mailing Address - Phone:734-243-0370
Mailing Address - Fax:734-243-2803
Practice Address - Street 1:15175 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-5038
Practice Address - Country:US
Practice Address - Phone:734-243-0370
Practice Address - Fax:734-243-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003613152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty