Provider Demographics
NPI:1639606700
Name:O'DWYER, ASHLEY M (OD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:M
Last Name:O'DWYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:RYCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:750 STEWART RD #2
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-9692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 STEWART RD STE 2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4279
Practice Address - Country:US
Practice Address - Phone:734-636-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist