Provider Demographics
NPI:1568777076
Name:VIDA, RYAN STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:STEPHEN
Last Name:VIDA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:4353 PARK TERRACE DR
Mailing Address - Street 2:STE 150
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4631
Mailing Address - Country:US
Mailing Address - Phone:805-987-5300
Mailing Address - Fax:805-987-5330
Practice Address - Street 1:4353 PARK TERRACE DR
Practice Address - Street 2:STE 150
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4631
Practice Address - Country:US
Practice Address - Phone:805-987-5300
Practice Address - Fax:805-987-5330
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2947152W00000X, 152WC0802X
CA14584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management