Provider Demographics
NPI:1932172004
Name:VEATCH, RYAN (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:VEATCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 W CHERRY ST
Mailing Address - Street 2:STE 1
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9047
Mailing Address - Country:US
Mailing Address - Phone:319-354-5030
Mailing Address - Fax:
Practice Address - Street 1:660 W CHERRY ST
Practice Address - Street 2:STE 1
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9047
Practice Address - Country:US
Practice Address - Phone:319-354-5030
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0082859Medicaid
IAV06314Medicare UPIN
IAI15909Medicare ID - Type Unspecified