Provider Demographics
NPI:1932438124
Name:DR RYAN VERXAGIO OD PA
Entity type:Organization
Organization Name:DR RYAN VERXAGIO OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CARLO
Authorized Official - Last Name:VERXAGIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-439-2015
Mailing Address - Street 1:1315 SILK OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1367
Mailing Address - Country:US
Mailing Address - Phone:305-439-2015
Mailing Address - Fax:305-503-9250
Practice Address - Street 1:1315 SILK OAK DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1367
Practice Address - Country:US
Practice Address - Phone:305-439-2015
Practice Address - Fax:305-503-9250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3957152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621009100Medicaid
V05250Medicare UPIN
FL621009100Medicaid
FLCV355AMedicare PIN