Provider Demographics
NPI:1598962755
Name:ORGILL, RYAN SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SCOTT
Last Name:ORGILL
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 1:225 E MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:GRANTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84029-9030
Mailing Address - Country:US
Mailing Address - Phone:435-249-0530
Mailing Address - Fax:435-249-0532
Practice Address - Street 1:225 E MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029-9030
Practice Address - Country:US
Practice Address - Phone:435-249-0530
Practice Address - Fax:435-249-0532
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT66302019934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT999000797009Medicaid
UT87017934007001OtherBLUE CROSS/BLUE SHIELD
UT87017934028001OtherBLUE CROSS/BLUE SHIELD
UT999000797009Medicaid
UT0618950011Medicare NSC