Healthcare Provider Details

I. General information

NPI: 1447243852
Provider Name (Legal Business Name): DENNIS CARL RYCZEK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 CENTRAL AVE
SAINT PETERSBURG FL
33707-6131
US

IV. Provider business mailing address

5412 CENTRAL AVE
SAINT PETERSBURG FL
33707-6131
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-8855
  • Fax: 727-323-0720
Mailing address:
  • Phone: 727-327-8855
  • Fax: 727-323-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC1962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: