Provider Demographics
NPI:1013035765
Name:RYAN, PATRICK J
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:RYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 ORONDO AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2826
Mailing Address - Country:US
Mailing Address - Phone:509-662-4747
Mailing Address - Fax:509-663-5338
Practice Address - Street 1:351 ORONDO AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2826
Practice Address - Country:US
Practice Address - Phone:509-662-4747
Practice Address - Fax:509-663-5338
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO00000334156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2008381Medicaid
WA2008381Medicaid