Provider Demographics
NPI:1578640744
Name:KAYS, RYAN H (OD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:H
Last Name:KAYS
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 1:200 W DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1906
Mailing Address - Country:US
Mailing Address - Phone:815-663-8281
Mailing Address - Fax:815-663-8190
Practice Address - Street 1:1802 N DIVISION ST STE 205
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3134
Practice Address - Country:US
Practice Address - Phone:815-942-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7215175OtherBCBS
IL046009918OtherDPA/TPA LICENSE
IL046009918Medicaid
IL208479Medicare PIN
ILIL6520Medicare PIN
ILIL6520002Medicare PIN
IL046009918Medicaid
IL6643640001Medicare NSC
IL046009918OtherDPA/TPA LICENSE