Provider Demographics
NPI:1639584873
Name:ROTTMAN, RYAN SETH (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SETH
Last Name:ROTTMAN
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 1:7900 SHELBYVILLE RD STE A15
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5463
Mailing Address - Country:US
Mailing Address - Phone:502-327-8568
Mailing Address - Fax:
Practice Address - Street 1:7900 SHELBYVILLE RD STE A15
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-327-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2133DT152WC0802X, 152W00000X, 152WC0802X
GAOPT002822152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100622220Medicaid