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General NPI Number Information
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NPI Number | 1174413926
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Entity Type | Individual
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Provider Name | RYAN DAMIEN HERRON OD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 1470D PLEASANT VALLEY RD
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City | MANCHESTER
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State | CT
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Zip | 06042-8761
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Country | US
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Telephone | 860-812-6267
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Fax |
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Provider Business Mailing Address
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Address Line | 82 ST IVES WAY APT 34
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City | MARLBOROUGH
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State | MA
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Zip | 01752-5921
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Country | US
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Telephone | 727-494-9038
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3411
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License Number State | CT
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