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General NPI Number Information
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NPI Number | 1750349973
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Entity Type | Individual
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Provider Name | CHRYSTYNA RAKOCZY OD
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Gender | Female
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 1800 LOMBARD ST SUITE 701 PEPPER PAVILION
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City | PHILADELPHIA
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State | PA
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Zip | 19146-8400
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Country | US
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Telephone | 215-893-2457
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Fax | 215-893-7514
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Provider Business Mailing Address
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Address Line | 1304 SOCIETY DR
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City | CLAYMONT
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State | DE
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Zip | 19703-1743
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Country | US
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Telephone | 302-798-5777
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Fax | 302-798-4277
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OEG000665
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License Number State | PA
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