Healthcare Provider Details

I. General information

NPI: 1790783041
Provider Name (Legal Business Name): NICHOLAS TODD RANSON M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 BUSINESS PARK DR
TRAVERSE CITY MI
49686-8683
US

IV. Provider business mailing address

929 BUSINESS PARK DR
TRAVERSE CITY MI
49686-8683
US

V. Phone/Fax

Practice location:
  • Phone: 231-947-6246
  • Fax: 231-947-8864
Mailing address:
  • Phone: 231-594-7062
  • Fax: 231-594-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number2024004550
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2024004550
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberMD00042059
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00042059
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: