Provider Demographics
NPI:1043572738
Name:HAYES, RYAN GRANT (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:GRANT
Last Name:HAYES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 E PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1810
Mailing Address - Country:US
Mailing Address - Phone:267-736-6335
Mailing Address - Fax:
Practice Address - Street 1:3031 S HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-3629
Practice Address - Country:US
Practice Address - Phone:435-259-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-09
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60427821152W00000X
MTOPT-OPT-LIC-3089152W00000X
UT8331523-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOD60427821OtherSTATE LICENSE
MTOPT-OPT-LIC-3089OtherSTATE LICENSE
UT8331523-9934OtherSTATE LICENSE