Provider Demographics
NPI:1205043684
Name:CZYZ, CRAIG (DO)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:CZYZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3371
Mailing Address - Country:US
Mailing Address - Phone:614-395-5644
Mailing Address - Fax:614-297-7753
Practice Address - Street 1:21178 OLEAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6728
Practice Address - Country:US
Practice Address - Phone:941-629-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58-001590207W00000X
FLOS10225207W00000X, 207WX0200X
OH34.009294207WX0200X
PAOS014584207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology