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General NPI Number Information
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NPI Number | 1134590359
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Entity Type | Organization
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Legal Business Name | DR CHELSEA RYZUK
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 579 FOLLY ROAD SUITE 14083
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City | CHARLESTON
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State | SC
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Zip | 29412
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Country | US
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Telephone | 843-481-5459
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 63559
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City | PHILADELPHIA
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State | PA
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Zip | 19147-7359
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. CHELSEA RYZUK
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Credential | OD
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Telephone | 843-481-5459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00662500
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License Number State | NJ
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