Healthcare Provider Details

I. General information

NPI: 1487761680
Provider Name (Legal Business Name): WILLIAM JOSEPH RYAN III O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MIDDLESEX RD
TYNGSBORO MA
01879-1070
US

IV. Provider business mailing address

560 E BROADWAY
HAVERHILL MA
01830-2423
US

V. Phone/Fax

Practice location:
  • Phone: 978-649-3880
  • Fax: 978-649-4708
Mailing address:
  • Phone: 978-373-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3137
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: