Healthcare Provider Details

I. General information

NPI: 1952768491
Provider Name (Legal Business Name): RYAN STYBEL OPTOMETRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 EMERSON AVE
LOS ANGELES CA
90045-1406
US

IV. Provider business mailing address

8009 DENROCK AVE
LOS ANGELES CA
90045-1114
US

V. Phone/Fax

Practice location:
  • Phone: 248-212-5120
  • Fax:
Mailing address:
  • Phone: 248-212-5120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN SCOTT STYBEL
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 248-212-5120