Provider Demographics
NPI:1417235037
Name:CAZARES, RYAN ANTONIO (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ANTONIO
Last Name:CAZARES
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 1:5511 CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-5201
Mailing Address - Country:US
Mailing Address - Phone:337-704-2260
Mailing Address - Fax:337-706-8172
Practice Address - Street 1:5511 CAMERON ST
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-5201
Practice Address - Country:US
Practice Address - Phone:337-298-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1609-642T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist