Provider Demographics
NPI:1881612620
Name:CHORYAN, RICHARD J
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:CHORYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:803 W STATE ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1660
Practice Address - Country:US
Practice Address - Phone:269-945-9724
Practice Address - Fax:269-945-9727
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900001357OtherPRIORITY HEALTH
MIRC002687OtherBCBS
MIRC002687OtherBCBS