Healthcare Provider Details
I. General information
NPI: 1881796316
Provider Name (Legal Business Name): RYAN R FARRAR O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 09/04/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2381 N KANSAS AVE
LIBERAL KS
67901-2055
US
IV. Provider business mailing address
2381 N KANSAS AVE
LIBERAL KS
67901-2055
US
V. Phone/Fax
- Phone: 620-624-1679
- Fax: 620-624-6001
- Phone: 620-624-1679
- Fax: 620-624-6001
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WV0400X |
| Taxonomy | Vision Therapy Optometrist |
| License Number | 2302 |
| License Number State | OK |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | 1568 |
| License Number State | KS |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | 2302 |
| License Number State | OK |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WC0802X |
| Taxonomy | Corneal and Contact Management Optometrist |
| License Number | 1568 |
| License Number State | KS |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WC0802X |
| Taxonomy | Corneal and Contact Management Optometrist |
| License Number | 2302 |
| License Number State | OK |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WL0500X |
| Taxonomy | Low Vision Rehabilitation Optometrist |
| License Number | 1568 |
| License Number State | KS |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WL0500X |
| Taxonomy | Low Vision Rehabilitation Optometrist |
| License Number | 2302 |
| License Number State | OK |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WP0200X |
| Taxonomy | Pediatric Optometrist |
| License Number | 1568 |
| License Number State | KS |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WP0200X |
| Taxonomy | Pediatric Optometrist |
| License Number | 2302 |
| License Number State | OK |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WS0006X |
| Taxonomy | Sports Vision Optometrist |
| License Number | 1568 |
| License Number State | KS |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WS0006X |
| Taxonomy | Sports Vision Optometrist |
| License Number | 2302 |
| License Number State | OK |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WV0400X |
| Taxonomy | Vision Therapy Optometrist |
| License Number | 1568 |
| License Number State | KS |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WX0102X |
| Taxonomy | Occupational Vision Optometrist |
| License Number | 1568 |
| License Number State | KS |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WX0102X |
| Taxonomy | Occupational Vision Optometrist |
| License Number | 2302 |
| License Number State | OK |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
