Healthcare Provider Details

I. General information

NPI: 1639606700
Provider Name (Legal Business Name): ASHLEY M O'DWYER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY RYCKMAN OD

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 E PARKS HWY
WASILLA AK
99654-7039
US

IV. Provider business mailing address

285 E PARKS HWY
WASILLA AK
99654-7039
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-3917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005055
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: