Healthcare Provider Details

I. General information

NPI: 1578640744
Provider Name (Legal Business Name): RYAN H KAYS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N DIVISION ST STE 205
MORRIS IL
60450-3134
US

IV. Provider business mailing address

200 W DAKOTA ST
SPRING VALLEY IL
61362-1906
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-3042
  • Fax:
Mailing address:
  • Phone: 815-663-8281
  • Fax: 815-663-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046009918
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: