Provider Demographics
NPI:1720279250
Name:SHEA, RYAN P (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:P
Last Name:SHEA
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:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-0519
Mailing Address - Country:US
Mailing Address - Phone:508-693-3517
Mailing Address - Fax:508-696-8570
Practice Address - Street 1:28 STATE ROAD
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568
Practice Address - Country:US
Practice Address - Phone:508-693-3517
Practice Address - Fax:508-696-8570
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist