Provider Demographics
NPI:1003461666
Name:RICKETTS, CHARIS-ANN (OD)
Entity Type:Individual
Prefix:
First Name:CHARIS-ANN
Middle Name:
Last Name:RICKETTS
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 1:60 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2400
Mailing Address - Fax:
Practice Address - Street 1:89-44 164TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6103
Practice Address - Country:US
Practice Address - Phone:718-523-2123
Practice Address - Fax:718-523-5833
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5661152W00000X
NYTUV009750-01152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist