Provider Demographics
NPI:1659333870
Name:BROWN, RYAN J (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:BROWN
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 1:1202 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4115
Mailing Address - Country:US
Mailing Address - Phone:515-576-1261
Mailing Address - Fax:515-576-0224
Practice Address - Street 1:1202 2ND AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4115
Practice Address - Country:US
Practice Address - Phone:515-576-1261
Practice Address - Fax:515-576-0224
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1293670Medicaid
IA34895OtherBLUE CROSS OF IOWA
IA5486680001OtherCIGNA MEDICARE
IAPLAMETTOOtherRAILROAD MEDICARE
IA1293670Medicaid
IA5486680001OtherCIGNA MEDICARE