Provider Demographics
NPI:1215169933
Name:DIMIT, RYAN PATRICK (OD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PATRICK
Last Name:DIMIT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 KIETZKE LN STE 103
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2063
Mailing Address - Country:US
Mailing Address - Phone:775-329-2300
Mailing Address - Fax:775-329-5514
Practice Address - Street 1:5420 KIETZKE LN STE 103
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2063
Practice Address - Country:US
Practice Address - Phone:775-329-2300
Practice Address - Fax:775-329-5514
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7474TG152WC0802X, 152W00000X
NV996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215169933Medicaid
TX00E63GMedicare UPIN
TX8L17874Medicare UPIN
TX112409104Medicaid