Provider Demographics
NPI:1558506402
Name:POWELL, ROBERT RYAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RYAN
Last Name:POWELL
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 1:893 SHUTTLEWORTH DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-7242
Mailing Address - Country:US
Mailing Address - Phone:515-306-2786
Mailing Address - Fax:
Practice Address - Street 1:893 SHUTTLEWORTH DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-7242
Practice Address - Country:US
Practice Address - Phone:515-306-2786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002447152W00000X
CO0002956152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist