Active NPI
Kevin Michael Ryan, O.D.
- Optometrist
- Peoria, IL
National Provider Identifier
1811272263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046010468
- Practice address
- 5201 W War Memorial Dr
Peoria, IL 61615-9222 - Phone
- (309) 282-1002
- Fax
- (309) 282-1003
- NPI assigned
- Oct 17, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046010468 | IL | Primary |
Addresses
Primary practice location
5201 W War Memorial Dr
Peoria, IL 61615-9222
Mailing address
5201 W War Memorial Dr
Peoria, IL 61615-9222
Phone (309) 282-1002
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046010468 | IL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318809600000",
"number": "1811272263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5201 W WAR MEMORIAL DR",
"city": "PEORIA",
"state": "IL",
"postal_code": "616159222",
"telephone_number": "309-282-1002",
"fax_number": "309-282-1003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5201 W WAR MEMORIAL DR",
"city": "PEORIA",
"state": "IL",
"postal_code": "616159222",
"telephone_number": "309-282-1002",
"fax_number": "309-282-1003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYAN",
"first_name": "KEVIN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-17",
"last_updated": "2011-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046010468",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.