Basic Information
| Provider Information | |||||||||
| NPI: | 1194464040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CZUMA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 W WEND ST | ||||||||
| Address2: | |||||||||
| City: | LEMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604394492 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 214 S WABASH AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606042303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125880401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2022 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046011613 | IL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.