Provider Demographics
NPI:1992060321
Name:KOSTRANCHUK, BIANCA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:MARIE
Last Name:KOSTRANCHUK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 CENTER ST STE C
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-8952
Mailing Address - Country:US
Mailing Address - Phone:440-286-9555
Mailing Address - Fax:440-286-6005
Practice Address - Street 1:373 CENTER ST STE C
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-8952
Practice Address - Country:US
Practice Address - Phone:440-286-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist