Provider Demographics
NPI:1033594825
Name:RUDYAK, LIANNA (OD)
Entity Type:Individual
Prefix:
First Name:LIANNA
Middle Name:
Last Name:RUDYAK
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 1:3032 CLEMENT ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1889
Mailing Address - Country:US
Mailing Address - Phone:650-534-8353
Mailing Address - Fax:
Practice Address - Street 1:3032 CLEMENT ST UNIT 101
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1889
Practice Address - Country:US
Practice Address - Phone:650-534-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist