Provider Demographics
NPI:1235257882
Name:RYAN, RAYMOND RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:RICHARD
Last Name:RYAN
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 1:6821 N COUNTRY HOMES BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4373
Mailing Address - Country:US
Mailing Address - Phone:509-344-2020
Mailing Address - Fax:509-344-2021
Practice Address - Street 1:6821 N COUNTRY HOMES BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4373
Practice Address - Country:US
Practice Address - Phone:509-344-2020
Practice Address - Fax:509-344-2021
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001332152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024164Medicaid
WA2024164Medicaid
WAU21208Medicare UPIN