MEDICARE: CHASE RATZLAFF 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	2906	OK

General Provider Information

NPI Number	:	1043763436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASE RATZLAFF O.D.

Provider Business Mailing Address
First Line	:	1204 W WILLOW RD STE A
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-2531
Country	:	US
Telephone Number	:	580-234-2333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1204 W WILLOW RD STE A
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-2531
Country	:	US
Telephone Number	:	580-234-2333
Fax Number	:

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

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	08/02/2016

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