Provider Demographics
NPI:1477734291
Name:JOHN A. KRUSZEWSKI O.D., INC
Entity Type:Organization
Organization Name:JOHN A. KRUSZEWSKI O.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:
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:419-843-2020
Mailing Address - Street 1:3723 KING RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1417
Mailing Address - Country:US
Mailing Address - Phone:419-843-2020
Mailing Address - Fax:419-843-8733
Practice Address - Street 1:3723 KING RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1417
Practice Address - Country:US
Practice Address - Phone:419-843-2020
Practice Address - Fax:419-843-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3869T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0814793Medicaid
KR0687812Medicare PIN
OH0698912Medicare UPIN
OH0580690001Medicare NSC