Provider Demographics
NPI:1437374659
Name:PALMER, RYAN GLENN (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:GLENN
Last Name:PALMER
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 1:257 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1903
Mailing Address - Country:US
Mailing Address - Phone:402-426-4601
Mailing Address - Fax:402-426-4710
Practice Address - Street 1:257 S 19TH ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1903
Practice Address - Country:US
Practice Address - Phone:402-426-4601
Practice Address - Fax:402-426-4710
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5646T2560152W00000X
KY1715DT152W00000X
NE1299152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000547841OtherBCBS
KY0656022Medicare PIN
000000547841OtherBCBS