Provider Demographics
NPI:1578598033
Name:RYAN, WILLIAM GUNNING (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GUNNING
Last Name:RYAN
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:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-0966
Mailing Address - Country:US
Mailing Address - Phone:804-443-3901
Mailing Address - Fax:804-443-6458
Practice Address - Street 1:611 DELLA STREET
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-0966
Practice Address - Country:US
Practice Address - Phone:804-443-3901
Practice Address - Fax:804-443-6458
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000514152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009204032Medicaid
VACM7564OtherMEDICARE RAILROAD
VA009204032Medicaid
VA00X992W01Medicare PIN