Healthcare Provider Details

I. General information

NPI: 1659341451
Provider Name (Legal Business Name): JOHN P CZAJA OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 BROADWAY SUITE A
MERRILLVILLE IN
46410-6215
US

IV. Provider business mailing address

8100 BROADWAY
MERRILLVILLE IN
46410-6215
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-2020
  • Fax: 219-756-8937
Mailing address:
  • Phone: 219-769-2020
  • Fax: 219-756-8937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002875A & B
License Number StateIN

VIII. Authorized Official

Name: DR. JOHN P CZAJA
Title or Position: PRESIDENT
Credential: OD
Phone: 219-769-2020