Provider Demographics
NPI:1174413926
Name:HERRON, RYAN DAMIEN (OD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DAMIEN
Last Name:HERRON
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 1:82 ST IVES WAY APT 34
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-5921
Mailing Address - Country:US
Mailing Address - Phone:727-494-9038
Mailing Address - Fax:
Practice Address - Street 1:1470D PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8761
Practice Address - Country:US
Practice Address - Phone:860-812-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist