Provider Demographics
NPI:1508931627
Name:MILES, RYAN
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:MILES
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3509 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2501
Mailing Address - Country:US
Mailing Address - Phone:816-753-2020
Mailing Address - Fax:816-753-2697
Practice Address - Street 1:3509 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2501
Practice Address - Country:US
Practice Address - Phone:816-753-2020
Practice Address - Fax:816-753-2697
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005017513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317387504Medicaid