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Individual
DR. MICHAEL RYAN DERHODGE
Active
Individual
DR. MICHAEL RYAN DERHODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC4605
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149YE
BC/BS OF FLORIDA
FL
01
—
OPC4605
FLORIDA DEPARTMENT OF HEALTH LICENSE
FL
Enumeration date
09/24/2010
Last updated
01/30/2013
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