Provider Demographics
NPI:1568556132
Name:SUBLER, RYAN MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:SUBLER
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 1:2174 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2902
Mailing Address - Country:US
Mailing Address - Phone:859-341-2566
Mailing Address - Fax:859-341-2568
Practice Address - Street 1:2174 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-2902
Practice Address - Country:US
Practice Address - Phone:859-341-2566
Practice Address - Fax:859-341-2568
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5663152W00000X
KY1753DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5663OtherSTATE LICENSE
KY7100057440Medicaid
KY000000579103OtherANTHEM
KY7100172260Medicaid
KY1753DTOtherKENTUCKY LICENSE
KY9334410Medicare PIN
KY7100057440Medicaid