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General NPI Number Information
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NPI Number | 1427232933
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Entity Type | Organization
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Legal Business Name | WILLIAM G. RYAN, O.D., LTD.
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 611 DELLA STREET
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City | TAPPAHANNOCK
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State | VA
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Zip | 22560-0966
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Country | US
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Telephone | 180-443-3901
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Fax | 804-443-6458
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Provider Business Mailing Address
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Address Line | PO BOX 966
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City | TAPPAHANNOCK
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State | VA
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Zip | 22560-0966
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Country | US
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Telephone | 804-443-3901
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Fax | 804-443-6458
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM G. RYAN
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Credential | O.D.
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Telephone | 804-443-3901
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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 | 0618000514
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 0618000514
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License Number State | VA
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