Provider Demographics
NPI:1063755676
Name:RYAN COYLE OD PS
Entity type:Organization
Organization Name:RYAN COYLE OD PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-295-7076
Mailing Address - Street 1:PO BOX 10937
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-1937
Mailing Address - Country:US
Mailing Address - Phone:509-454-5253
Mailing Address - Fax:509-454-5254
Practice Address - Street 1:2310 LONGFIBRE AVE
Practice Address - Street 2:
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903-1513
Practice Address - Country:US
Practice Address - Phone:509-454-5253
Practice Address - Fax:509-454-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 60161298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty