Provider Demographics
NPI:1700094109
Name:VINCENT, RYAN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:VINCENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:800-542-7956
Mailing Address - Fax:641-754-6245
Practice Address - Street 1:2020 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8772
Practice Address - Country:US
Practice Address - Phone:515-232-2450
Practice Address - Fax:515-232-3532
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6755207W00000X
KS04-35204207W00000X
MO2011026868207W00000X
IAMD-41715207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist