Provider Demographics
NPI:1225362486
Name:EYES OF BISMARCK PLLC
Entity Type:Organization
Organization Name:EYES OF BISMARCK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:D
Authorized Official - Last Name:CZYWCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-223-3780
Mailing Address - Street 1:2821 ROCK ISLAND PL
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7720
Mailing Address - Country:US
Mailing Address - Phone:701-223-3780
Mailing Address - Fax:701-222-1732
Practice Address - Street 1:2821 ROCK ISLAND PL
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7720
Practice Address - Country:US
Practice Address - Phone:701-223-3780
Practice Address - Fax:701-222-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty