MEDICARE: DR. RYAN GREGORY FELTEN 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
1	152W00000X	Optometrist	2052	AZ

General Provider Information

NPI Number	:	1407239254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN GREGORY FELTEN O.D.

Provider Business Mailing Address
First Line	:	31521 N 48TH ST
Second Line	:
City	:	CAVE CREEK
State	:	AZ
Zip	:	85331-4403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12450 N 32ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7160
Country	:	US
Telephone Number	:	602-494-0054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	06/29/2015

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