Provider Demographics
NPI:1457760043
Name:ISAACSON, RYAN LAWRENCE (OD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LAWRENCE
Last Name:ISAACSON
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 1:513 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1013
Mailing Address - Country:US
Mailing Address - Phone:763-420-5112
Mailing Address - Fax:
Practice Address - Street 1:1502 WOODLANE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2221
Practice Address - Country:US
Practice Address - Phone:651-735-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist