Hazen Family Eyecare PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

681 Issued in ND

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

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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.NPI 1427281583

Title

Owner/Optometrist

Phone

(701) 516-2115

Specialties & licenses 1

Addresses

Other identifiers 4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Derek David Czywczynski, O.D.

  • Optometrist
  • Bemidji, MN
  • NPI 1427281583
  Authorized official Same address or phone

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": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "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"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12122586",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60698",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keely Christina Goter, D.D.S.
• Sherrie Sue Guenthner
• Hannah Hanson, DC
• Camille B. Harvey
• Hazen Drug Inc.
• Hazen Health Pharmacy
• Hazen Memorial Hospital Association (Sakakawea Hazen Clinic)
• Hazen Memorial Hospital Association (Sakakawea Clinic)
• Hazen Memorial Hospital Association (Sakakawea Home Health Care)
• Hazen Memorial Hospital Association (Sakakawea Medical Center)

• Optometrist in Hazen, ND
• Providers in Hazen, ND by specialty
• Optometrist in North Dakota

• 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.

Verify at the official NPI Registry.