Provider Demographics
NPI:1407321508
Name:NGO, RYAN NGHIEM (OD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:NGHIEM
Last Name:NGO
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:NGHIEM
Other - Middle Name:SY
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5043 86TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-2709
Mailing Address - Country:US
Mailing Address - Phone:503-380-2285
Mailing Address - Fax:
Practice Address - Street 1:4820 ROAD 68
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9009
Practice Address - Country:US
Practice Address - Phone:503-380-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60976602152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist