Provider Demographics
NPI:1720712854
Name:HOLIDAY, RYAN (OD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:HOLIDAY
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 1:1 SAGEBRUSH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-3942
Mailing Address - Country:US
Mailing Address - Phone:505-869-3200
Mailing Address - Fax:
Practice Address - Street 1:1 SAGEBRUSH ST SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3942
Practice Address - Country:US
Practice Address - Phone:505-869-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003825152W00000X
UT12844144-9934152W00000X
NMOPT-2023-0001152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist