MEDICARE: DEREK DAVID CZYWCZYNSKI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3667	MN

General Provider Information

NPI Number	:	1427281583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK DAVID CZYWCZYNSKI O.D.

Provider Business Mailing Address
First Line	:	2819 FOREST VIEW DR NE
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-9145
Country	:	US
Telephone Number	:	701-516-2115
Fax Number	:

Provider Business Practice Location Address
First Line	:	2819 FOREST VIEW DR NE
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-9145
Country	:	US
Telephone Number	:	701-516-2115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	12/21/2025

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