Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WV0400X | Optomitrist - Vision Therapist | 6338 | CA |
NPI | 1548487598 |
---|---|
Provider Name | Dr. Julie Berg Ryan |
First Address | Irvine, CA 92604-4671 |
Second Address | Irvine, CA 92604-4671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T96130 | (02) | CA |