Provider Demographics
NPI:1144327727
Name:RYSZKA, DONALD LEE (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEE
Last Name:RYSZKA
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 1:835 SOUTH MAIN STREET STE 4
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1282
Mailing Address - Country:US
Mailing Address - Phone:920-846-2845
Mailing Address - Fax:920-846-2845
Practice Address - Street 1:835 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1282
Practice Address - Country:US
Practice Address - Phone:920-846-2845
Practice Address - Fax:920-846-2845
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI01411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38572900Medicaid
WI38572900Medicaid
WIT63179Medicare UPIN
WI87810Medicare PIN