Provider Demographics
NPI:1215972146
Name:IMLER, RYAN D (OD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:D
Last Name:IMLER
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 1:108 OLDE FARM OFFICE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-9417
Mailing Address - Country:US
Mailing Address - Phone:814-695-3141
Mailing Address - Fax:814-696-4780
Practice Address - Street 1:108 OLDE FARM OFFICE RD
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-9417
Practice Address - Country:US
Practice Address - Phone:814-695-3141
Practice Address - Fax:814-696-4780
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000274152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0075369330002Medicaid
251387446OtherUNITED HEALTHCARE
410040534OtherMEDICARE RAILROAD
PA000360256OtherHIGHMARK
PAU75174Medicare UPIN
PA027276Medicare PIN