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General NPI Number Information
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NPI Number | 1164660221
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Entity Type | Organization
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Legal Business Name | RON RYAN MD PA
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 1917 KNOX MCRAE DR
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City | TITUSVILLE
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State | FL
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Zip | 32780-5360
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Country | US
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Telephone | 321-383-1332
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Fax | 321-383-1243
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Provider Business Mailing Address
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Address Line | 1917 KNOX MCRAE DR
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City | TITUSVILLE
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State | FL
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Zip | 32780-5360
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Country | US
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Telephone | 321-383-1332
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Fax | 321-383-1243
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD CHRISTOPHER RYAN
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Credential | M.D.
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Telephone | 321-383-1332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4171
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME0062417
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License Number State | FL
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