Provider Demographics
NPI:1316912868
Name:STUART, RYAN CRAIG (OD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CRAIG
Last Name:STUART
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:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-0760
Mailing Address - Country:US
Mailing Address - Phone:928-524-6171
Mailing Address - Fax:928-524-3963
Practice Address - Street 1:421 E IOWA ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025-2770
Practice Address - Country:US
Practice Address - Phone:928-524-6171
Practice Address - Fax:928-524-3963
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1414OtherSTATE LICENSE
AZ983876Medicaid
AZ983876Medicaid