Physician Compare National (NPI:1801981030)

HEALTHCARE PROVIDER: RYAN ELLWEIN OD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1801981030
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204837248
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070118000219
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ELLWEIN
	Individual professional last name
Provider First Name	RYAN
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	OD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3501 W 41ST ST
	Group Practice or individual's line 1 address
Line 2 Street Address	110B
	Group Practice or individual's line 2 address
City	SIOUX FALLS
	Group Practice or individual's city
State	SD
	Group Practice or individual's state
Zip Code	571060709
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y