Provider Demographics
NPI:1477749265
Name:CHRISTOPHER A RUZICKA & LAURA LACEY
Entity Type:Organization
Organization Name:CHRISTOPHER A RUZICKA & LAURA LACEY
Other - Org Name:RUZICKA & LACEY OPTOMETRIST
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RUZICKA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-682-0319
Mailing Address - Street 1:4180 TREAT BLVD
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8844T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADR7156Medicare PIN
CAEM272AMedicare PIN
CA0600120001Medicare NSC