Provider Demographics
NPI:1962559138
Name:DEMARES, RYAN (OD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:DEMARES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1121 AMERICAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-4923
Mailing Address - Country:US
Mailing Address - Phone:312-371-5633
Mailing Address - Fax:414-769-6998
Practice Address - Street 1:16025 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6001
Practice Address - Country:US
Practice Address - Phone:262-785-0490
Practice Address - Fax:262-785-1690
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2980-036152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIV03662Medicare UPIN