Provider Demographics
NPI:1578099339
Name:TSCHANTZ, KAILY MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KAILY
Middle Name:MARIE
Last Name:TSCHANTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAILY
Other - Middle Name:MARIE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3615 S ATLANTIC AVE
Mailing Address - Street 2:UNIT 202
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-2602
Mailing Address - Country:US
Mailing Address - Phone:407-353-9656
Mailing Address - Fax:
Practice Address - Street 1:701 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5331
Practice Address - Country:US
Practice Address - Phone:386-253-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC005357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist