Provider Demographics
NPI:1326614090
Name:RASNICK, CHELSEA ELIZABETH (OD)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:ELIZABETH
Last Name:RASNICK
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 1:310 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2326
Mailing Address - Country:US
Mailing Address - Phone:276-228-2771
Mailing Address - Fax:276-228-9097
Practice Address - Street 1:310 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2326
Practice Address - Country:US
Practice Address - Phone:276-228-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0168003027152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program