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General NPI Number Information
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NPI Number | 1558905588
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Entity Type | Organization
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Legal Business Name | RYAN NICHOLAS OD LLC
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Dates
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Enumeration Date | 11/02/2019
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Last Update Date | 11/02/2019
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Provider Practice Location Address
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Address Line | 4200 CONROY RD # B166
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City | ORLANDO
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State | FL
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Zip | 32839-2400
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Country | US
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Telephone | 407-473-3539
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Fax | 407-796-8602
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Provider Business Mailing Address
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Address Line | 5268 BASKIN ST
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City | ORLANDO
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State | FL
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Zip | 32814-6920
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Country | US
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Telephone | 909-542-5208
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RYAN NICHOLAS
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Credential | OD
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Telephone | 909-542-5208
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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 |
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License Number State |
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