Healthcare Provider Details

I. General information

NPI: 1235154956
Provider Name (Legal Business Name): RYAN SCOTT BENNION O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 W 200 N STE 200
ST GEORGE UT
84770-7386
US

IV. Provider business mailing address

161 W 200 N STE 200
ST GEORGE UT
84770-7386
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-3201
  • Fax: 435-922-7088
Mailing address:
  • Phone: 435-673-3201
  • Fax: 435-922-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00004064
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: