Provider Demographics
NPI:1649654369
Name:BECK, RYAN (OD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:BECK
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 1:1640 E SUNRISE BLVD
Mailing Address - Street 2:2405
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2397
Mailing Address - Country:US
Mailing Address - Phone:561-445-7983
Mailing Address - Fax:
Practice Address - Street 1:21126 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2404
Practice Address - Country:US
Practice Address - Phone:561-221-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 005054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist