Provider Demographics
NPI:1417323403
Name:SCEUSA, CHELSEA (OD)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:SCEUSA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:RYZUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 4495
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-4495
Mailing Address - Country:US
Mailing Address - Phone:720-309-9464
Mailing Address - Fax:720-222-5800
Practice Address - Street 1:200 MOSAIC CIR
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-5025
Practice Address - Country:US
Practice Address - Phone:912-348-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003118152W00000X
NJ27OA00662500152W00000X
GAOPT003379152W00000X
SC2270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2270OtherSTATE LICENSE