Provider Demographics
NPI:1497192553
Name:CLEARY, RIAN JAMES (OD)
Entity Type:Individual
Prefix:
First Name:RIAN
Middle Name:JAMES
Last Name:CLEARY
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 1:3300 EDINBOROUGH WAY
Mailing Address - Street 2:#412
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5923
Mailing Address - Country:US
Mailing Address - Phone:952-835-0874
Mailing Address - Fax:
Practice Address - Street 1:3300 EDINBOROUGH WAY
Practice Address - Street 2:#412
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5923
Practice Address - Country:US
Practice Address - Phone:952-835-0874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3332152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist