Healthcare Provider Details

I. General information

NPI: 1356759195
Provider Name (Legal Business Name): BRIANNA RYFF OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 W UTOPIA RD
GLENDALE AZ
85308-5251
US

IV. Provider business mailing address

19389 N 59TH AVE
GLENDALE AZ
85308-6500
US

V. Phone/Fax

Practice location:
  • Phone: 623-806-7200
  • Fax: 623-806-7210
Mailing address:
  • Phone: 623-537-6080
  • Fax: 623-537-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2826
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT-002058
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: