Provider Demographics
NPI:1235154956
Name:BENNION, RYAN SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SCOTT
Last Name:BENNION
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 1:23714 222ND PL SE STE B
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5800
Mailing Address - Country:US
Mailing Address - Phone:425-432-1206
Mailing Address - Fax:425-413-4465
Practice Address - Street 1:23714 222ND PL SE STE B
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038
Practice Address - Country:US
Practice Address - Phone:425-432-1206
Practice Address - Fax:425-413-4465
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00004064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2032084Medicaid
WA1235154956Medicare NSC
WA2032084Medicaid
WA8861450Medicare PIN