Provider Demographics
NPI:1962810531
Name:MCGIFFEN, RYAN (OD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:MCGIFFEN
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 1:327 EASTBROOKE POINTE DR 100
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-5561
Mailing Address - Country:US
Mailing Address - Phone:812-890-1229
Mailing Address - Fax:502-538-3551
Practice Address - Street 1:327 EASTBROOKE POINTE DR 100
Practice Address - Street 2:
Practice Address - City:MOUNT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-5561
Practice Address - Country:US
Practice Address - Phone:812-890-1229
Practice Address - Fax:502-538-3551
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1959DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist