MEDICARE: DR. CYNTHIA A CIESZKO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	GA1076T	GA

General Provider Information

NPI Number	:	1902895980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA A CIESZKO O.D.

Provider Business Mailing Address
First Line	:	4633 VILLAGE DR
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-5742
Country	:	US
Telephone Number	:	770-457-3618
Fax Number	:	770-698-8821

Provider Business Practice Location Address
First Line	:	4400 ASHFORD DUNWOODY RD NE
Second Line	:	1280 PERIMETER MALL
City	:	ATLANTA
State	:	GA
Zip	:	30346-1518
Country	:	US
Telephone Number	:	770-396-8070
Fax Number	:	770-698-8821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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