Provider Demographics
NPI:1932331295
Name:RATZENBERGER, DESIREE AJ (OD)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:AJ
Last Name:RATZENBERGER
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 1:2320 WHISPERING HILLS CT
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-1035
Mailing Address - Country:US
Mailing Address - Phone:248-342-2990
Mailing Address - Fax:
Practice Address - Street 1:50753 WATERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-4008
Practice Address - Country:US
Practice Address - Phone:586-913-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist