Provider Demographics
NPI:1619932720
Name:LEMPP, RYAN P (OD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:LEMPP
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 1:11507 S 42ND ST # 109
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-6006
Mailing Address - Country:US
Mailing Address - Phone:402-964-2700
Mailing Address - Fax:
Practice Address - Street 1:1601 AVE D
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-2559
Practice Address - Country:US
Practice Address - Phone:712-323-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1225152W00000X
IA2293152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0441659Medicaid
NE279351Medicaid
IA0441659Medicaid
NE279351Medicare PIN