Provider Demographics
NPI:1437319944
Name:RYAN W COWBURN OD
Entity Type:Organization
Organization Name:RYAN W COWBURN OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COWBURN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-349-1237
Mailing Address - Street 1:2121 SHELLY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2395
Mailing Address - Country:US
Mailing Address - Phone:724-349-1237
Mailing Address - Fax:724-465-0127
Practice Address - Street 1:2121 SHELLY DR
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2395
Practice Address - Country:US
Practice Address - Phone:724-349-1237
Practice Address - Fax:724-465-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty