Provider Demographics
NPI:1427232933
Name:WILLIAM G. RYAN, O.D., LTD.
Entity Type:Organization
Organization Name:WILLIAM G. RYAN, O.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-443-3901
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-0966
Mailing Address - Country:US
Mailing Address - Phone:804-443-3901
Mailing Address - Fax:804-443-6458
Practice Address - Street 1:611 DELLA STREET
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-0966
Practice Address - Country:US
Practice Address - Phone:180-443-3901
Practice Address - Fax:804-443-6458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000514152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0647860001Medicare NSC
C10678Medicare PIN
VAT21949Medicare UPIN