Provider Demographics
NPI:1134432230
Name:MCKINNIS, RYAN OWEN (OD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:OWEN
Last Name:MCKINNIS
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:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-9118
Mailing Address - Country:US
Mailing Address - Phone:330-583-4441
Mailing Address - Fax:330-583-4471
Practice Address - Street 1:9981 VAIL DR UNIT A2
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-4901
Practice Address - Country:US
Practice Address - Phone:330-583-4441
Practice Address - Fax:330-583-4471
Is Sole Proprietor?:No
Enumeration Date:2010-07-17
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist