MEDICARE: RYAN ALDER OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	113253-9934	UT

General Provider Information

NPI Number	:	1396800876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN ALDER OD

Provider Business Mailing Address
First Line	:	11103 WEST AVE
Second Line	:	SUITE 6
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1370
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	1134 E 2100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2802
Country	:	US
Telephone Number	:	801-463-2712
Fax Number	:	801-466-6271

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	07/08/2007

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Directions to “ RYAN ALDER OD” Practice Location

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