Provider Demographics
NPI:1427064427
Name:RYDER, JOHN T (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:RYDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1030 NORWOOD PARK BLVD
Mailing Address - Street 2:#A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-6600
Mailing Address - Country:US
Mailing Address - Phone:512-491-9707
Mailing Address - Fax:512-491-9735
Practice Address - Street 1:1030 NORWOOD PARK BLVD
Practice Address - Street 2:#A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-6600
Practice Address - Country:US
Practice Address - Phone:512-491-9707
Practice Address - Fax:512-491-9735
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX2156152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E50VMedicare ID - Type Unspecified