Provider Demographics
NPI:1255486213
Name:NEWMAN, RYAN JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOSEPH
Last Name:NEWMAN
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 1:919 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-2940
Mailing Address - Country:US
Mailing Address - Phone:785-890-3937
Mailing Address - Fax:785-890-3938
Practice Address - Street 1:919 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-2940
Practice Address - Country:US
Practice Address - Phone:785-890-3937
Practice Address - Fax:785-890-3938
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS205477995OtherTRICARE
KS200255000BMedicaid
KSP00469603OtherRAILROAD MEDICARE PART B
KS200255000BMedicaid
KSP00469603OtherRAILROAD MEDICARE PART B
KS205477995OtherTRICARE