Healthcare Provider Details

I. General information

NPI: 1992720064
Provider Name (Legal Business Name): RYAN MCKAY RICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/26/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 N UNION BLVD SUITE 140
COLORADO SPRINGS CO
80909-1120
US

IV. Provider business mailing address

2770 N UNION BLVD SUITE 140
COLORADO SPRINGS CO
80909-1120
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-9595
  • Fax: 719-227-0669
Mailing address:
  • Phone: 719-473-9595
  • Fax: 719-227-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberDR.0046281
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDR.0046281
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: