Provider Demographics
NPI:1700313236
Name:RYAN T BARLOW OD LLC
Entity Type:Organization
Organization Name:RYAN T BARLOW OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:385-393-0145
Mailing Address - Street 1:390 E 500 S
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1088
Mailing Address - Country:US
Mailing Address - Phone:385-393-0145
Mailing Address - Fax:
Practice Address - Street 1:2228 W 1700 S
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-7126
Practice Address - Country:US
Practice Address - Phone:801-775-9884
Practice Address - Fax:801-775-9886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9832838-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty