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General NPI Number Information
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NPI Number | 1124680129
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Entity Type | Individual
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Provider Name | KRISTINA BYZYKA
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 2914 CENTRAL ST
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City | EVANSTON
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State | IL
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Zip | 60201-1237
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Country | US
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Telephone | 847-864-4768
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Fax |
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Provider Business Mailing Address
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Address Line | 2225 SWEET CIDER RD
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City | FORT WAYNE
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State | IN
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Zip | 46818-8860
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Country | US
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Telephone | 260-715-1056
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.011323
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License Number State | IL
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