Provider Demographics
NPI:1912229683
Name:RYAN ELLWEIN OD PC
Entity Type:Organization
Organization Name:RYAN ELLWEIN OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLWEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-271-9060
Mailing Address - Street 1:3501 W 41ST ST
Mailing Address - Street 2:STE 110 B
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-0709
Mailing Address - Country:US
Mailing Address - Phone:605-271-9060
Mailing Address - Fax:605-271-9062
Practice Address - Street 1:3501 W 41ST ST
Practice Address - Street 2:STE 110 B
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-0709
Practice Address - Country:US
Practice Address - Phone:605-271-9060
Practice Address - Fax:605-271-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD595261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9203364Medicaid
SDU98623Medicare UPIN