Provider Demographics
NPI:1790730158
Name:BEYER, RYAN MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:BEYER
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 1:3607 ROAD 99
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-3218
Mailing Address - Country:US
Mailing Address - Phone:919-314-7845
Mailing Address - Fax:
Practice Address - Street 1:416 VALLEY VIEW DR STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-1444
Practice Address - Country:US
Practice Address - Phone:308-635-1633
Practice Address - Fax:308-365-2880
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1567152W00000X
NC2011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V09387Medicare UPIN
NC2474056Medicare PIN
NC5903810Medicaid
VA010338352Medicaid
VA1790730158Medicaid
NC2474056AMedicare PIN
NC2474056BMedicare PIN
NC2474056DMedicare PIN
VA012589M40Medicare PIN