Provider Demographics
NPI:1497748016
Name:RYAN, PATRICK WA (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WA
Last Name:RYAN
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 1:3410 PUMP RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1111
Mailing Address - Country:US
Mailing Address - Phone:804-364-1837
Mailing Address - Fax:804-364-1698
Practice Address - Street 1:3410 PUMP RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1111
Practice Address - Country:US
Practice Address - Phone:804-364-1837
Practice Address - Fax:804-364-1698
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA410037465OtherRAILROAD MEDICARE
410000056Medicare PIN
VA410037465OtherRAILROAD MEDICARE