Healthcare Provider Details

I. General information

NPI: 1427281583
Provider Name (Legal Business Name): DEREK DAVID CZYWCZYNSKI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 FOREST VIEW DR NE
BEMIDJI MN
56601-9145
US

IV. Provider business mailing address

2819 FOREST VIEW DR NE
BEMIDJI MN
56601-9145
US

V. Phone/Fax

Practice location:
  • Phone: 701-516-2115
  • Fax:
Mailing address:
  • Phone: 701-516-2115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3667
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: