Provider Demographics
NPI:1821087859
Name:MCKINNON, RYAN S (MD-OPTHALMOLOGY)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:S
Last Name:MCKINNON
Suffix:
Gender:M
Credentials:MD-OPTHALMOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7170
Mailing Address - Country:US
Mailing Address - Phone:928-344-2000
Mailing Address - Fax:
Practice Address - Street 1:2270 S RIDGEVIEW DR STE 303
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8866
Practice Address - Country:US
Practice Address - Phone:928-336-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ73191207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDDM255OtherBLUE CROSS
ID1821087859Medicaid
ID12062OtherBLUE CROSS
ID080036991OtherRAILROAD MEDICARE
ID20002185Medicare PIN
ID12062OtherBLUE CROSS
F59864Medicare UPIN