Provider Demographics
NPI:1093836991
Name:DEPAOLIS AND RYAN OD, PC
Entity Type:Organization
Organization Name:DEPAOLIS AND RYAN OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-271-2990
Mailing Address - Street 1:169 RUE DE VL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5619
Mailing Address - Country:US
Mailing Address - Phone:585-271-2990
Mailing Address - Fax:585-271-6321
Practice Address - Street 1:169 RUE DE VL
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5619
Practice Address - Country:US
Practice Address - Phone:585-271-2990
Practice Address - Fax:585-271-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005025332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY017410959OtherBLUE CHOICE
NY1082520001Medicare NSC