Provider Demographics
NPI:1427188374
Name:RYAN, VANCE EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:VANCE
Middle Name:EDWARD
Last Name:RYAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10019 E MOUNTAIN VIEW RD UNIT 2092
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-6326
Mailing Address - Country:US
Mailing Address - Phone:480-219-7304
Mailing Address - Fax:480-219-7304
Practice Address - Street 1:21001 N TATUM BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4206
Practice Address - Country:US
Practice Address - Phone:480-419-9750
Practice Address - Fax:480-419-9752
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ167475OtherEYEMED