Provider Demographics
NPI:1356840573
Name:OBERHOLTZER, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:OBERHOLTZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-3160
Mailing Address - Country:US
Mailing Address - Phone:717-632-5558
Mailing Address - Fax:
Practice Address - Street 1:1 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-3160
Practice Address - Country:US
Practice Address - Phone:717-632-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician