Healthcare Provider Details

I. General information

NPI: 1619932720
Provider Name (Legal Business Name): RYAN P LEMPP OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 AVE D
COUNCIL BLUFFS IA
51501-2559
US

IV. Provider business mailing address

11507 S 42ND ST # 109
BELLEVUE NE
68123-6006
US

V. Phone/Fax

Practice location:
  • Phone: 712-323-5213
  • Fax:
Mailing address:
  • Phone: 402-964-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1225
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2293
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2293
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: