Basic Information
| Provider Information | |||||||||
| NPI: | 1124680129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYZYKA | ||||||||
| FirstName: | KRISTINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2225 SWEET CIDER RD | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468188860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607151056 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2914 CENTRAL ST | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602011237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478644768 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2019 | ||||||||
| LastUpdateDate: | 07/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046.011323 | IL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.