Provider Demographics
NPI:1750349973
Name:RAKOCZY, CHRYSTYNA (OD)
Entity type:Individual
Prefix:
First Name:CHRYSTYNA
Middle Name:
Last Name:RAKOCZY
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 1:1304 SOCIETY DR
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-1743
Mailing Address - Country:US
Mailing Address - Phone:302-798-5777
Mailing Address - Fax:302-798-4277
Practice Address - Street 1:1800 LOMBARD ST
Practice Address - Street 2:SUITE 701 PEPPER PAVILION
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-8400
Practice Address - Country:US
Practice Address - Phone:215-893-2457
Practice Address - Fax:215-893-7514
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1211903Medicaid
PA0062431000OtherPA BLUE CROSS
PA1211903Medicaid