Provider Demographics
NPI:1447243852
Name:RYCZEK, DENNIS CARL (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:CARL
Last Name:RYCZEK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-6131
Mailing Address - Country:US
Mailing Address - Phone:727-327-8855
Mailing Address - Fax:727-323-0720
Practice Address - Street 1:5412 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-6131
Practice Address - Country:US
Practice Address - Phone:727-327-8855
Practice Address - Fax:727-323-0720
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1962152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19288OtherBLUE CROSS BLUE SHIELD
FL410044753OtherRAILROAD MEDICARE
FL084726700Medicaid
FL19288CMedicare PIN
FL410044753OtherRAILROAD MEDICARE
FL72807Medicare PIN