Healthcare Provider Details

I. General information

NPI: 1679487797
Provider Name (Legal Business Name): RYLEE POWELL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 WILLIAM ST
CAPE GIRARDEAU MO
63703-6574
US

IV. Provider business mailing address

PO BOX 145
OWENSVILLE MO
65066-0145
US

V. Phone/Fax

Practice location:
  • Phone: 573-335-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2026047328
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: