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General NPI Number Information
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NPI Number | 1417129883
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Entity Type | Organization
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Legal Business Name | DONALD L RYSZKA OD
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 835 SOUTH MAIN ST STE 4
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City | OCONTO FALLS
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State | WI
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Zip | 54154-1282
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Country | US
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Telephone | 920-846-2845
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Fax | 920-846-2845
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Provider Business Mailing Address
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Address Line | 835 SOUTH MAIN ST STE 4
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City | OCONTO FALLS
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State | WI
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Zip | 54154-1282
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Country | US
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Telephone | 920-846-2845
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Fax | 920-846-2845
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Authorized Official
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Title or Position | OPTOMETRIST OWNER
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Name | DR. DONALD L RYSZKA
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Credential | OD
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Telephone | 920-846-2845
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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 | 01411
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License Number State | WI
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