Provider Demographics
NPI:1134113517
Name:CIZEK, KATHRYN A (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:A
Last Name:CIZEK
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 1:3830 WEST FRONT ST.
Mailing Address - Street 2:CEDAR RUN EYE CENTER
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-8868
Mailing Address - Country:US
Mailing Address - Phone:231-929-3888
Mailing Address - Fax:231-929-4365
Practice Address - Street 1:3830 W FRONT ST
Practice Address - Street 2:CEDAR RUN EYE CENTER
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8153
Practice Address - Country:US
Practice Address - Phone:231-929-3888
Practice Address - Fax:231-929-4365
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900B86347OtherBLUE CROSS BLUE SHIELD
MI1020070001OtherDMERC REG B
MICN1586OtherRAILROAD MEDICARE
MI943166469Medicaid
MICN1586OtherRAILROAD MEDICARE
MI943166469Medicaid
MI0B86347001Medicare PIN