Healthcare Provider Details

I. General information

NPI: 1598962755
Provider Name (Legal Business Name): RYAN SCOTT ORGILL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E MAIN ST SUITE E
GRANTSVILLE UT
84029-9030
US

IV. Provider business mailing address

225 E MAIN ST SUITE E
GRANTSVILLE UT
84029-9030
US

V. Phone/Fax

Practice location:
  • Phone: 435-249-0530
  • Fax: 435-249-0532
Mailing address:
  • Phone: 435-249-0530
  • Fax: 435-249-0532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number66302019934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: