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General NPI Number Information
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NPI Number | 1437374659
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Entity Type | Individual
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Provider Name | RYAN GLENN PALMER O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2007
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 257 S 19TH ST
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City | BLAIR
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State | NE
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Zip | 68008-1903
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Country | US
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Telephone | 402-426-4601
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Fax | 402-426-4710
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Provider Business Mailing Address
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Address Line | 257 S 19TH ST
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City | BLAIR
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State | NE
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Zip | 68008-1903
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Country | US
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Telephone | 402-426-4601
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Fax | 402-426-4710
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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 | 5646T2560
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1715DT
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1299
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License Number State | NE
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