Provider Demographics
NPI:1164621561
Name:KLUEMPER, RYAN GEOFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:GEOFFREY
Last Name:KLUEMPER
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 1:1001 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1963
Mailing Address - Country:US
Mailing Address - Phone:812-421-2020
Mailing Address - Fax:
Practice Address - Street 1:1001 WALNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1963
Practice Address - Country:US
Practice Address - Phone:812-421-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003447A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201043510Medicaid