Provider Demographics
NPI:1720468044
Name:BERGER, RYAN ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ALAN
Last Name:BERGER
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 1:4207 GLASS RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2538
Mailing Address - Country:US
Mailing Address - Phone:319-366-4455
Mailing Address - Fax:319-362-8461
Practice Address - Street 1:4207 GLASS RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2538
Practice Address - Country:US
Practice Address - Phone:319-366-4455
Practice Address - Fax:319-362-8461
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist