Provider Demographics
NPI:1508368556
Name:RUZICKA, AMY (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:RUZICKA
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 1:2120 APALACHEE PKWY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4819
Mailing Address - Country:US
Mailing Address - Phone:850-273-7158
Mailing Address - Fax:
Practice Address - Street 1:2120 APALACHEE PKWY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4819
Practice Address - Country:US
Practice Address - Phone:850-273-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003517152W00000X
MDTA29554152W00000X
FLOPC5722152W00000X
KY2098DT152W00000X
OHT3499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist