Provider Demographics
NPI:1649344862
Name:RYAN, PAUL
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 AUDUBON VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2262
Mailing Address - Country:US
Mailing Address - Phone:610-650-9124
Mailing Address - Fax:610-650-9125
Practice Address - Street 1:2816 AUDUBON VILLAGE DR
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-2262
Practice Address - Country:US
Practice Address - Phone:610-650-9124
Practice Address - Fax:610-650-9125
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-001130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040849OtherDAVIS VISION
PA204721OtherEYEMED
PA396852OtherNVA
PA2579100OtherAETNA
PA26431OtherSPECTERA
PAPA87555OtherVBA
PA396852OtherNVA
PA204721OtherEYEMED