Provider Demographics
NPI:1902965254
Name:CHRYCY, GARRY THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:THOMAS
Last Name:CHRYCY
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 1:1661 SW 37TH AVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1754
Mailing Address - Country:US
Mailing Address - Phone:305-443-3786
Mailing Address - Fax:305-443-3783
Practice Address - Street 1:1661 SW 37TH AVE
Practice Address - Street 2:STE. 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1754
Practice Address - Country:US
Practice Address - Phone:305-443-3786
Practice Address - Fax:305-443-3783
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1263152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078831700Medicaid
U27433Medicare UPIN
FL078831700Medicaid