Provider Demographics
NPI:1679744940
Name:RYAN C STUART OD PC
Entity Type:Organization
Organization Name:RYAN C STUART OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-535-3879
Mailing Address - Street 1:1942 W 7TH SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937
Mailing Address - Country:US
Mailing Address - Phone:928-536-7941
Mailing Address - Fax:
Practice Address - Street 1:2824 HIGHWAY 260
Practice Address - Street 2:SUITE 5
Practice Address - City:OVERGAARD
Practice Address - State:AZ
Practice Address - Zip Code:85933
Practice Address - Country:US
Practice Address - Phone:928-535-3879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZVO7766Medicare UPIN