Provider Demographics
NPI:1720606742
Name:EISEL, RYAN W (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:W
Last Name:EISEL
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 1:9190 SPRINGFIELD RD APT 19C
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3198
Mailing Address - Country:US
Mailing Address - Phone:330-277-1997
Mailing Address - Fax:
Practice Address - Street 1:201 W LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1103
Practice Address - Country:US
Practice Address - Phone:330-424-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist