Healthcare Provider Details

I. General information

NPI: 1700094109
Provider Name (Legal Business Name): RYAN DAVID VINCENT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 PHILADELPHIA ST
AMES IA
50010-8772
US

IV. Provider business mailing address

309 E CHURCH ST
MARSHALLTOWN IA
50158-2946
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-2450
  • Fax: 515-232-3532
Mailing address:
  • Phone: 800-542-7956
  • Fax: 641-754-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberN6755
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number04-35204
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2011026868
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD-41715
License Number StateIA
# 5
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-41715
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: