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General NPI Number Information
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NPI Number | 1093836991
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Entity Type | Organization
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Legal Business Name | DEPAOLIS AND RYAN OD, PC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 169 RUE DE VL
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City | ROCHESTER
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State | NY
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Zip | 14618-5619
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Country | US
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Telephone | 585-271-2990
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Fax | 585-271-6321
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Provider Business Mailing Address
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Address Line | 169 RUE DE VL
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City | ROCHESTER
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State | NY
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Zip | 14618-5619
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Country | US
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Telephone | 585-271-2990
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Fax | 585-271-6321
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ROBERT A RYAN
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Credential | OD
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Telephone | 585-271-2990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 005025
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License Number State | NY
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