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General NPI Number Information
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NPI Number | 1932331295
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Entity Type | Individual
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Provider Name | DESIREE A.J. RATZENBERGER O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/19/2009
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 50753 WATERSIDE DR
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City | CHESTERFIELD
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State | MI
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Zip | 48051-4008
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Country | US
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Telephone | 586-913-8001
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Fax |
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Provider Business Mailing Address
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Address Line | 2320 WHISPERING HILLS CT
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City | WASHINGTON
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State | MI
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Zip | 48094-1035
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Country | US
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Telephone | 248-342-2990
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Fax |
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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 | 4901004532
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License Number State | MI
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