Healthcare Provider Details

I. General information

NPI: 1780634782
Provider Name (Legal Business Name): RYAN RIDGES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 S KELLY AVE STE A
EDMOND OK
73013-3929
US

IV. Provider business mailing address

PO BOX 410108
KANSAS CITY MO
64141-0108
US

V. Phone/Fax

Practice location:
  • Phone: 405-607-6699
  • Fax: 405-607-6685
Mailing address:
  • Phone: 405-607-6699
  • Fax: 405-607-6685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036135701
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number31674
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number31674
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: