Provider Demographics
NPI:1932542842
Name:WISE, RYAN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOHN
Last Name:WISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2424 CENTURY PL SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4031
Mailing Address - Country:US
Mailing Address - Phone:828-322-2050
Mailing Address - Fax:828-345-0522
Practice Address - Street 1:2424 CENTURY PL SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4031
Practice Address - Country:US
Practice Address - Phone:828-322-2050
Practice Address - Fax:828-345-0522
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-00378207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5817994OtherAETNA
NC1932542842Medicaid
NC19WTPOtherBCBS
NC5817994OtherENVOLVE
NCA34493OtherEYEMED