Provider Demographics
NPI:1992813414
Name:RUZICKA, CHRISTOPHER ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:RUZICKA
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 1:4180 TREAT BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-1858
Mailing Address - Country:US
Mailing Address - Phone:925-682-0319
Mailing Address - Fax:925-676-0966
Practice Address - Street 1:4180 TREAT BLVD
Practice Address - Street 2:STE B
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-1858
Practice Address - Country:US
Practice Address - Phone:925-682-0319
Practice Address - Fax:925-676-0966
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8844T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEM288YMedicare PIN
CA0600120001Medicare NSC
CAP00959442Medicare PIN
CAU28971Medicare UPIN