MEDICARE: LIANNA RUDYAK O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	15381	CA

General Provider Information

NPI Number	:	1033594825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANNA RUDYAK O.D

Provider Business Mailing Address
First Line	:	3032 CLEMENT ST UNIT 101
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-1889
Country	:	US
Telephone Number	:	650-534-8353
Fax Number	:

Provider Business Practice Location Address
First Line	:	3032 CLEMENT ST UNIT 101
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-1889
Country	:	US
Telephone Number	:	650-534-8353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	07/21/2022

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