Healthcare Provider Details

I. General information

NPI: 1104177104
Provider Name (Legal Business Name): RYAN MICHAEL DUGAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/22/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 ANDALE RD
ANDALE KS
67001-9656
US

IV. Provider business mailing address

228 N ANDALE RD
ANDALE KS
67001-9656
US

V. Phone/Fax

Practice location:
  • Phone: 316-393-8872
  • Fax:
Mailing address:
  • Phone: 316-444-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1939
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: