Provider Demographics
NPI:1992720064
Name:RICH, RYAN MCKAY (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MCKAY
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 N UNION BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1120
Mailing Address - Country:US
Mailing Address - Phone:719-473-9595
Mailing Address - Fax:719-227-0669
Practice Address - Street 1:2770 N UNION BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1120
Practice Address - Country:US
Practice Address - Phone:719-473-9595
Practice Address - Fax:719-227-0669
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0046281207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67174787Medicaid
COCO300999Medicare PIN
I38007Medicare UPIN
FL2732297-00Medicaid
FL16900Medicare PIN