Provider Demographics
NPI:1740335058
Name:KARL S. CSISZER, O.D., P.C.
Entity type:Organization
Organization Name:KARL S. CSISZER, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:STEFAN
Authorized Official - Last Name:CSISZER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-786-2020
Mailing Address - Street 1:1112 E RAILROAD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1894
Mailing Address - Country:US
Mailing Address - Phone:815-786-2020
Mailing Address - Fax:815-786-6306
Practice Address - Street 1:1112 E RAILROAD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1894
Practice Address - Country:US
Practice Address - Phone:815-786-2020
Practice Address - Fax:815-786-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-006611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT38704Medicare ID - Type Unspecified
IL762580Medicare UPIN
IL0229190001Medicare NSC