Provider Demographics
NPI:1487427316
Name:CHRENCIK, RYAN (OD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CHRENCIK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5769 BENT TREE DR
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-7604
Mailing Address - Country:US
Mailing Address - Phone:989-350-7702
Mailing Address - Fax:
Practice Address - Street 1:12910 SHELBYVILLE RD STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2404
Practice Address - Country:US
Practice Address - Phone:855-259-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist