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NPI Code Detail

MEDICARE: DR. SYLVIA RYAN-BODEN O.D.

MEDICARE: DR. SYLVIA RYAN-BODEN O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist850AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11225216971OTHERAZPROVIDER NPI
21225364110OTHERAZCORPORATE NPI

General Provider Information

NPI Number : 1225216971
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SYLVIA RYAN-BODEN O.D.
Provider Business Mailing Address
First Line : 3370 E CANARY WAY
Second Line :
City : CHANDLER
State : AZ
Zip : 85286-5682
Country : US
Telephone Number : 480-899-6464
Fax Number : 480-899-0199
Provider Business Practice Location Address
First Line : 2974 N ALMA SCHOOL RD
Second Line : STE 3
City : CHANDLER
State : AZ
Zip : 85224-6713
Country : US
Telephone Number : 480-899-6464
Fax Number : 480-899-0199
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2008
Last Update Date : 01/06/2010

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