Provider Demographics
NPI:1659341451
Name:JOHN P CZAJA OD PC
Entity Type:Organization
Organization Name:JOHN P CZAJA OD PC
Other - Org Name:EYE DESIGNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CZAJA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-769-2020
Mailing Address - Street 1:8100 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6215
Mailing Address - Country:US
Mailing Address - Phone:219-769-2020
Mailing Address - Fax:219-756-8937
Practice Address - Street 1:8100 BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6215
Practice Address - Country:US
Practice Address - Phone:219-769-2020
Practice Address - Fax:219-756-8937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002875A & B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200866690 AMedicaid
IN200866690 AMedicaid
INU68966Medicare UPIN