Active NPI
Donald Henry Czelusniak, OD
- Optometrist
- Fitchburg, MA
National Provider Identifier
1720181266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2164
- Practice address
- 76 Summer St
Ste 120
Fitchburg, MA 01420 - Phone
- (978) 345-3556
- Fax
- (978) 342-9251
- NPI assigned
- Sep 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2164 | MA | Primary |
Addresses
Primary practice location
76 Summer St
Ste 120
Fitchburg, MA 01420
Mailing address
PO Box 1430
76 Summer St
Fitchburg, MA 01420
Phone (978) 345-3556
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0399043 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2164 | MA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275436800000",
"number": "1720181266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1430",
"address_2": "76 SUMMER ST",
"city": "FITCHBURG",
"state": "MA",
"postal_code": "01420",
"telephone_number": "978-345-3556",
"fax_number": "978-342-9251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "76 SUMMER ST",
"address_2": "STE 120",
"city": "FITCHBURG",
"state": "MA",
"postal_code": "01420",
"telephone_number": "978-345-3556",
"fax_number": "978-342-9251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CZELUSNIAK",
"first_name": "DONALD",
"middle_name": "HENRY",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2010-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "2164",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0399043",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fitchburg, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.