Provider Demographics
NPI:1508941410
Name:RYAN, ELIZABETH ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9433
Mailing Address - Country:US
Mailing Address - Phone:413-323-1196
Mailing Address - Fax:413-323-1186
Practice Address - Street 1:142 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007
Practice Address - Country:US
Practice Address - Phone:413-323-1196
Practice Address - Fax:413-323-1186
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3455152W00000X
CT002412152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0356166Medicaid
MA443758Medicare ID - Type UnspecifiedPROVIDER #
MAU11827Medicare UPIN