Provider Demographics
NPI:1154071389
Name:ROLES, RYANN KATHERINE (OD)
Entity Type:Individual
Prefix:DR
First Name:RYANN
Middle Name:KATHERINE
Last Name:ROLES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RYANN
Other - Middle Name:KATHERINE
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:208 MORROW ST S
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-2510
Practice Address - Country:US
Practice Address - Phone:479-394-4215
Practice Address - Fax:479-394-3455
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AR2847152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program