Provider Demographics
NPI:1184690950
Name:RYAN, DARCY CALVIN (OD)
Entity type:Individual
Prefix:DR
First Name:DARCY
Middle Name:CALVIN
Last Name:RYAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2977 REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2445
Mailing Address - Country:US
Mailing Address - Phone:562-595-4366
Mailing Address - Fax:562-595-6092
Practice Address - Street 1:2977 REDONDO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2445
Practice Address - Country:US
Practice Address - Phone:562-595-4366
Practice Address - Fax:562-595-6092
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11208TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU84823Medicare UPIN