Active NPI
Hazen Family Eyecare PC
- Optometrist
- Hazen, ND
National Provider Identifier
1306266291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 681
- Legal business name
- HAZEN FAMILY EYECARE PC
- Practice address
- 104 12TH Ave NW
Suite #1
Hazen, ND 58545-4100 - Phone
- (701) 748-5220
- Fax
- (701) 748-5221
- NPI assigned
- Apr 18, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Derek David Czywczynski, O.D.
- Title
- Owner/Optometrist
- Phone
- (701) 516-2115
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 681 | ND | Primary |
Addresses
Primary practice location
104 12TH Ave NW
Suite #1
Hazen, ND 58545-4100
Mailing address
104 12TH Ave NW
Suite #1
Hazen, ND 58545-4100
Phone (701) 748-5220
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60698 | Medicaid | ND | |
| 12122586 | Other | ND | CAQH |
| 1427281583 | Other | ND | OPTOMETRIST NPI |
| 681 | Other | ND | STATE LICENSE NUMBER |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397779200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1306266291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 12TH AVE NW",
"address_2": "SUITE #1",
"city": "HAZEN",
"state": "ND",
"postal_code": "585454100",
"telephone_number": "701-748-5220",
"fax_number": "701-748-5221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 12TH AVE NW",
"address_2": "SUITE #1",
"city": "HAZEN",
"state": "ND",
"postal_code": "585454100",
"telephone_number": "701-748-5220",
"fax_number": "701-748-5221"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HAZEN FAMILY EYECARE PC",
"organizational_subpart": "NO",
"enumeration_date": "2014-04-18",
"last_updated": "2023-03-07",
"status": "A",
"authorized_official_last_name": "CZYWCZYNSKI",
"authorized_official_first_name": "DEREK",
"authorized_official_middle_name": "DAVID",
"authorized_official_title_or_position": "OWNER/OPTOMETRIST",
"authorized_official_telephone_number": "701-516-2115",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "ND",
"license": "681",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60698",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "12122586",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTOMETRIST NPI",
"identifier": "1427281583",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "681",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hazen, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.