Provider Demographics
NPI:1497757967
Name:KRUSZEWSKI, JOHN ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:KRUSZEWSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 KING RD
Mailing Address - Street 2:
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:
Practice Address - Street 1:3723 KING RD
Practice Address - Street 2:SUITE100
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
Is Sole Proprietor?:No
Enumeration Date:2005-08-13
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000137598OtherANTHEM
OH0580690001OtherDMERC
OH03067OtherPARAMOUNT
OH0814793Medicaid
OH22-00959OtherUNITED HEALTH CARE
OH900E86700OtherBCBS OF MICHIGAN
OH22-00959OtherUNITED HEALTH CARE
OHT527Medicare UPIN
OH0814793Medicaid